Discrimination and health outcomes in England's black communities amid the cost-of-living crisis: evaluating the role of inflation and Bank Rates

To systematically review the available evidence on the impact of organizational partnerships on public health outcomes (health improvement and/or a reduction in health inequalities) in England between 1997 and 2008. Systematic review of quantitative (longitudinal before and after) and qualitative studies (1997-2008) reporting on the health (and health inequalities) effects of public health partnerships in England. Eighteen electronic databases (medical, social science and economic), websites, bibliographies and expert contacts. Only 15 studies, relating to six different interventions, met the review criteria and most of these studies were not designed specifically to assess the impact of partnership working on public health outcomes. Of the studies reviewed, only four included a quantitative element and they produced a mixed picture in terms of the impacts of partnership working. Qualitative studies suggested that some partnerships increased the profile of health inequalities on local policy agendas. Both the design of partnership interventions and of the studies evaluating them meant it was difficult to assess the extent to which identifiable successes and failures were attributable to partnership working. This systematic review suggests that there is not yet any clear evidence of the effects of public health partnerships on health outcomes. More appropriately designed and timed studies are required to establish whether, and how, partnerships are effective.

BackgroundCommunity resilience is a relevant concept in public health, but its empirical relationship with health outcomes remains underexplored. This study examines whether a Community Resilience Index (CRI) is associated with population health outcomes in England, and whether it offers explanatory added value beyond the Index of Multiple Deprivation (IMD).MethodsThe CRI comprises 44 indicators reflecting community-level resilience to chronic stressors. Associations between CRI scores and five health outcomes, deaths of despair, cardiovascular disease (CVD) mortality, COVID-19 mortality, excess all-cause mortality during two waves of COVID-19 and self-rated health were assessed at local authority district level. IMD was adjusted to remove health-related indicators. Linear regression models assessed the explanatory power of the CRI and IMD, using likelihood ratio tests to compare model fit. Interaction and stratified analyses explored effect modification by IMD.ResultsHigher CRI scores were associated with lower Deaths of Despair and CVD mortality, and higher self-rated health; these associations remained significant after adjusting for IMD. CRI was not significantly associated with COVID-19 outcomes. IMD remained the stronger predictor of health outcomes, but CRI significantly improved model fit. The interaction between CRI and IMD was significant for deaths of despair and self-rated health. Stratified analyses showed the CRI–deaths of despair association was strongest in more deprived areas.ConclusionsCommunity resilience is associated with health outcomes in England. While not a substitute for deprivation-based measures, resilience indices offer complementary insight into structural and social factors shaping health. Resilience-building efforts may be particularly impactful in areas of greatest disadvantage.

ABSTRACTIn his 1999 article with Breusch, Qian, and Wyhowski in the Journal of Econometrics, Peter Schmidt introduced the concept of “redundant” moment conditions. Such conditions arise when estimation is based on moment conditions that are valid and can be divided into two subsets: one that identifies the parameters and another that provides no further information. Their framework highlights an important concept in the moment-based estimation literature, namely, that not all valid moment conditions need be informative about the parameters of interest. In this article, we demonstrate the empirical relevance of the concept in the context of the impact of government health expenditure on health outcomes in England. Using a simulation study calibrated to this data, we perform a comparative study of the finite performance of inference procedures based on the Generalized Method of Moment (GMM) and info-metric (IM) estimators. The results indicate that the properties of GMM procedures deteriorate as the number of redundant moment conditions increases; in contrast, the IM methods provide reliable point estimators, but the performance of associated inference techniques based on first order asymptotic theory, such as confidence intervals and overidentifying restriction tests, deteriorates as the number of redundant moment conditions increases. However, for IM methods, it is shown that bootstrap procedures can provide reliable inferences; we illustrate such methods when analysing the impact of government health expenditure on health outcomes in England.

Analysis of the Association of Residents in Radiation Oncology Equity and Inclusion Subcommittee (ARRO EISC) Black History Month (BHM) Campaign: Moving Beyond Awareness

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Persistent inequalities in relation to health outcomes continue to exist among patients identifying as lesbian, gay, and bisexual (LGB), and very little is known about outcomes specific to bisexual populations. This study’s aim was to compare the health of individuals identifying as LGB with heterosexual counterparts within primary care in England. Cross-sectional survey data from the year 10 (2015/2016) English General Practice Patient Survey (GPPS) dataset, which consisted of 836,312 responses (38.9% response rate), including 23,834 people who identified as gay, lesbian, bisexual or “other” was analyzed. Health outcomes were assessed through self-reported quality of life, physical and mental health, and confidence in managing own health. Multifactorial logistic regression (adjusting for age, ethnic group, working status, and socioeconomic status) were conducted. Long-term physical and mental health problems were more than twice as likely to be reported for people within LGB groups compared to the heterosexual group for both genders, except bisexual women where the odds were more than four times greater (OR = 4.275, 95% CI, 3.896, 4.691; p < .001). Bisexual women were half as likely to report the absence of a long-term health problem (OR = 0.452, 95% CI 0.419, 0.488; p < .001). LGB groups across both genders, reported a higher proportion of individuals that did not feel confident in managing their health and experienced significantly worse quality of life compared to heterosexuals. LGB patients consistently report poorer health outcomes than heterosexual patients. Bisexual people of both genders consistently experienced worse physical and mental health outcomes compared with the other recorded sexual orientations.

When observed in K-12 public schools, Black History Month is often decontextualized and features traumatic representations alongside simplistic tales of individual success. This miseducation (Woodson, 1933) has long faced resistance, as Carter G. Woodson’s intention for Negro History Week (1926) offered a vision for something new. Now, nearly 100 years later, educators are rectifying false narratives, acting with agency, proactively educating themselves, and standing up for justice alongside others. Utilizing a Liberatory Black History Month instructional framework, salient practices used to subvert Eurocentric Black History Month (BHM) curricula and the systemic and local barriers are shared, along with implications for future research.

Six million people in England live in areas where the level of fluoride in water is adjusted to reduce the significant public health burden of dental caries. The dental effects of fluoride are well established, but evidence for suggested adverse health effects is limited, with a lack of rigorous small area population studies that control for confounding. This study aims to test the association between water fluoridation schemes and selected health outcomes using the best available routine data sources. Ecological level exposure to fluoridated water was estimated for standard small areas and administrative districts in England using Geographical Information Systems and digitized boundaries based on known patterns of water supply. The association between fluoridation and dental and nondental health indicators was tested using multivariable regression models including ecological level confounding variables. Health indicator data were obtained from routine sources. There was strong evidence of lower prevalence of dental caries (P<0.001) among children living in fluoridated areas, they also had fewer teeth affected on average (P<0.001), and lower admission rates for tooth extraction (55% lower; 95% CI-73%, -27%; P=0.001). There was no strong evidence of an association between fluoridation and hip fracture, Down syndrome, all-cancer, all-cause mortality or osteosarcoma. Fluoridation was negatively associated with the incidence of renal stones (7.9% lower; 95% CI-9.6%,-6.2%; P<0.001) and bladder cancer (8.0% lower; 95% CI-9.9%,-6.0%; P<0.001). This study uses the comprehensive data sets available in England to provide reassurance that fluoridation is a safe and highly effective public health measure to reduce dental decay. Although lower rates of certain nondental outcomes were found in fluoridated areas, the ecological, observational design prohibits any conclusions being drawn regarding a protective role of fluoridation.

Fluoridation may not be linked with adverse health outcomes

ObjectivesThe purpose of this systematic review is to explore the effectiveness of the National Health Inequality Strategy, which was conducted in England between 1999 and 2010.DesignThree databases (Ovid Medline, Embase...

BackgroundHereditary Spastic Paraplegia (HSP) is a rare genetic neurological disorder that causes progressive spasticity and weakness in the lower limbs. This study aims to describe the prevalence and incidence of HSP and examine common mental health outcomes (depression and anxiety) in HSP patients in England and Northern Ireland.MethodsThis retrospective cohort study used CPRD Aurum primary care data from 1 January 2000 to 31 December 2021. Annual cross-sectional and cohort studies were conducted for yearly prevalence and incidence of HSP. Common mental health outcomes were examined with a 1:4 matched cohort (age+/−1 year, sex, general practice). Descriptive analysis and logistic regression assessed the characteristics of the HSP cohort and baseline depression and anxiety. Cox regression assessed the hazard of new diagnosis of depression and anxiety.ResultsThe overall cohort included 31,302,579 patients; the matched cohort included 1455 HSP patients and 5726 control non-HSP patients. Patients who were male (adjusted odds ratio [aOR] 1.45, 95% CI: 1.31–1.61), of White ethnicity (lower odds in all other ethnicity) and from most other geographical areas compared to London had higher odds of a HSP diagnosis, with the highest odds for North East (aOR 3.51, 95% CI: 2.73–4.50) and Northern Ireland (aOR 3.15, 95% CI: 1.62–6.16). HSP prevalence increased from 2.83 per 100,000 population (95% CI: 2.49–3.20) in 2000 to 6.27 per 100,000 population (95% CI: 5.83–6.73) in 2021. HSP incidence remained stable from 0.12 per 100,000 person-years (95% CI: 0.06–0.22) in 2000 to 0.29 per 100,000 person-years (95% CI: 0.20–0.40) in 2021. HSP patients had higher odds of baseline pre-existing depression (aOR: 1.74, 95% CI: 1.47–2.06) and anxiety (aOR: 1.31, 95% CI: 1.08–1.60); and higher hazard for new diagnosis of depression (adjusted hazard ratio [aHR]: 1.57, 95% CI: 1.26–1.96) and anxiety (aHR: 1.41, 95% CI: 1.12–1.76).ConclusionThis first descriptive epidemiological study for HSP in England and Northern Ireland, demonstrated the utility of primary care routine health records for studying rare diseases. The higher rates of common mental health conditions in HSP patients illustrated the importance of access to mental health support.

The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England

A Note from the Editor Virginia M. Brennan Black History Month, 2011 One hundred and fifty years ago, "[i]n 1861, as the United States stood at the brink of Civil War, people of African descent, both enslaved and free persons, waited with a watchful eye. They understood that a war between the North and the South might bring about jubilee—the destruction of slavery and universal freedom. When the Confederacy fired upon Fort Sumter and war ensued, President Abraham Lincoln maintained that the paramount cause was to preserve the Union, not end slavery. Frederick Douglass, the most prominent black leader, opined that regardless of intentions, the war would bring an end to slavery, America's 'peculiar institution.' "Over the course of the war, the four million people of African descent in the United States proved Douglass right. Free and enslaved blacks rallied around the Union flag in the cause of freedom. From the cotton and tobacco fields of the South to the small towns and big cities of the North, nearly 200,000 joined the Grand Army of the Republic and took up arms to destroy the Confederacy. They served as recruiters, soldiers, nurses, and spies, and endured unequal treatment, massacres, and riots as they pursued their quest for freedom and equality. Their record of service speaks for itself, and Americans have never fully realized how their efforts saved the Union. "In honor of the efforts of people of African descent to destroy slavery and inaugurate universal freedom in the United States, the Association for the Study of African American Life and History has selected 'African Americans and the Civil War' as the 2011 National Black History Theme. We urge all Americans to study and reflect on the value of their contributions to the nation." —from the Association for the Study of African American Life and History website Each February, JHCPU is proud to publish its Black History Month issue. While the public health and health policy articles we publish ineluctably cleave to the present-day, it still seems fitting to pause with the Association for the Study of African American Life and History to note the 150-year anniversary of the onset of the U.S. Civil War and the resulting abolition of the institution of legal slavery in the United States. We hope that the work in these pages contributes to the ascending spiral of African American life in the U.S. that began so long ago. Opening with Jim Withers's powerful ACU Column recounting the story of providers in Pittsburgh walking the extra mile to care for people who are homeless, this issue continues with two Literature Reviews. The first, by Ndumele and colleagues, covers research published between 1993 and 2009 on focus group research among Black and [End Page vii] Hispanic populations in the U.S.; it contributes to ongoing efforts to understand differences in research participation between members of minority groups and others. The second, by Felder and colleagues, covers research regarding the effectiveness of pharmaceutical assistance programs, specifically with respect to their contributions towards glycemic and lipid control. The rest of the issue falls into four parts: Part 1: Faith, Altruism, and the Family Part 2: Racial/Ethnic Health Disparities Part 3: Clinical Care Part 4: Health Policy The issue closes with several Letters to the Editor. Part 1: Faith, Altruism, and the Family. The core cultural values of faith, altruism, and the family constitute the topics of the first part of this Black History Month issue. The Commentary by Asomugha and colleagues advocates the establishment of a national faith-based health research network to help systematize and evaluate the valuable work that many churches and other religious organizations do on behalf of the health of the underserved. Carreon and colleagues studied the American Dental Education Association's survey of dental school seniors with an eye towards which respondents showed evidence of altruism in their professional plans. As others have found for medical students and physicians, Carreon and colleagues found that the most significant predictors of greater altruism were membership in a racial/ethnic minority group and/or a personal history of low socioeconomic status. The work underscores again the importance of...

Associations between adolescents’ experience of general practitioners and health outcomes in England: a cross-sectional study of national data

“Ebony” Magazine and Lerone Bennett Jr.: Popular Black History in Postwar America