Using data to improve the health of coastal communities: The Coda Network

Health on the agenda in Scottish independence referendum

Objective: To evaluate healthy life expectancy (HLE) as a measure of health inequalities by comparing geographical and area-based deprivation-related inequalities in healthy and total life expectancy (TLE). Design: Life table...

BackgroundSeveral epidemiological studies have investigated the effect of the quantity of green space on health outcomes such as self-rated health, morbidity and mortality ratios. These studies have consistently found positive...

Partnerships between medical schools and their clinical associates, which we describe in this article as academic clinical partnerships (ACPs), are powerful economic and social actors through their roles as major employers and procurers of goods and services. A broad spectrum of effects extending beyond the tripartite mission shapes the social contract between ACPs and the communities they serve. The authors present a model for identifying and measuring effects across this spectrum and illustrate the model's application with reference to specific case studies set in the United Kingdom. This model categorizes effects into five different domains: economic, human capital, social capital, knowledge, and place. These different effects express themselves along a spatial scale that varies from the very local to the global. The authors describe the theoretical background for each domain, as well as the methods required to identify and measure effects. These methods range from a quantitative economic impact analysis using extended input-output models to qualitative methods to capture social capital and place effects. The authors demonstrate how leaders in academic medicine can use the model to build a holistic picture of the societal effects of ACPs. Evidence of impact is of value to ACP leaders in engaging with both national and local stakeholders, and the approach is likely transferable to different countries.

Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010

Ensuring that the NHS realises fair financial value from its data

Back to table of contents Previous article Next article International NewsFull AccessBritish Health System Shifts Authority to Local AgenciesChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:17 Sep 2004https://doi.org/10.1176/pn.39.18.0390020aThe idea for a robust public health system in England was born in 1942, when mass casualties were expected during World War II. When the war ended, the idea of a welfare state with cradle-to-grave social services for all became popular in the country.The National Health Service (NHS) was envisioned to be tax supported, free to all, and based on community care, with general practitioners and community health centers at its core.The NHS, which was fully established in England by 1948, has continued to grow, becoming the largest governmental organization in Europe with more than 1 million employees, according to the NHS Web site.The government has run the NHS since 1948 without national standards, patient choice of health care providers or treatment, and adequate staffing or funding, according to a Department of Health (DoH) statement. The DoH is responsible for improving the health and well-being of England's population.In his re-election campaign, Prime Minister Tony Blair promised to reform the NHS and increase its funding. His government made good on that promise and is implementing a detailed plan for reform combined with modest funding increases.In 2002 a cabinet minister was appointed secretary for health and head of the DoH.The health secretary works with five health ministers. Each minister is responsible for several, often diverse, areas. For example, the minister responsible for adult mental health services also oversees dentistry, emergency care, diabetes, and patient and public involvement, said Richard Beinecke, D.P.A., at last month's Mental Health Policy Roundtable meeting at APA headquarters (Original article: see article above). He spent three months in the United Kingdom last spring to learn about the organization and delivery of general health, mental health, and social services.A major reform within the NHS is the transfer of service planning authority and funding from the central offices in London to locally based primary care trusts (organizations). “The goal is to design services around patients and put them first,” according to a report from the NHS.Strategic planning for NHS was delegated to 28 new health authorities renamed Strategic Health Authorities (SHA). Each SHA covers about 1.5 million people and develops plans for improving local health services and ensuring that the quality of services is high and national priorities are integrated into local health service plans, according to Beinecke.The government has promised that 75 percent of the NHS budget will be transferred to local health authorities, according to the NHS.The primary care trusts also decide which secondary services to contract for. Secondary care is specialized and covers mental health, integrated care, NHS hospitals, and ambulance services, Beinecke explained.People with severe mental illnesses including severe anxiety problems or psychotic illness usually are referred by their primary care physicians to specialists for mental health treatment, according to the NHS. For milder problems including marital and bereavement concerns, patients are generally advised to seek help from primary care professionals.Mental health teams work in community settings. Specialized care is provided by crisis resolution teams, assertive outreach teams, early intervention teams, and prison-in-reach teams, which support the health staff in prisons, said Beinecke.There has been a renewed emphasis on integrating general health, mental health, and social services funded by the NHS, Beinecke said. The 1999 Health Act allowed local authorities and the NHS to set up local integrated care organizations called “care trusts” and pool budgets, according to Beinecke.A small number of these trusts have been established, but more are expected in the future.A detailed description of the reorganized NHS is posted online at<www.nhs.uk/england/aboutTheNHS/default.cmsx>. The summary of the NHS plan is posted online at<www.publications.doh.gov.uk/deliveringthenhsplan.index.htm>.▪ ISSUES NewArchived

Health Policy In Two Nations: What A British Analyst Might Say

The challenges and opportunities of mental health data sharing in the UK

Healthy life expectancy (HLE) is a prominent summary indicator for evaluating and comparing the levels of population health status across Europe. Variations in HLE, however, do not necessarily reflect underlying differences in health and mortality levels among countries and are particularly sensitive when broken down by population subgroups. For instance, despite European countries showing large HLE inequalities by educational level, these countries are also highly heterogenous regarding their educational population composition, which most likely affects their HLE levels. We demonstrate how this compositional effect shapes HLE levels by providing HLE estimates of educational attainment and gender for 16 European countries using the Sullivan method. We use prevalence data about activities of daily living (ADLs) limitations from the European Union Statistics on Income and Living Conditions (EU-SILC) and mortality data from the Eurostat database. We then quantify the magnitude of educational inequalities based on the composite inequality index (CII). Finally, we express total HLE as the sum of education-specific HLEs, weighted by the educational population structure. As expected, we find large educational inequalities in HLE, with men's CII ranging from about 8.5 years in Portugal to approximately 3 years in Romania. For women, educational inequalities are slightly smaller. The decomposition reveals the population structure's strong effects on HLE, which can elicit misleading conclusions about people's health status and potentially turn HLE into an improper measure of educational differences as opposed to a measure of health gaps. For example, low-, medium-, and highly educated individuals in Portugal show more healthy life years than their counterparts in Poland. Still, Poland's total HLE value slightly exceeds that of Portugal, indicating favorable health and mortality conditions in Poland. However, Poland's greater relative number of highly educated individuals in its population is responsible for producing this higher total HLE value. We conclude that education is not only paramount for assessing health inequalities across European countries, but also the population composition by educational attainment, because it drives the differences in HLE levels.

Opioid abuse has become a public health concern among many developed countries, with policymakers searching for strategies to mitigate adverse effects on population health and the wider economy. The United Kingdom has seen dramatic increases in opioid-related mortality following the financial crises in 2008. We examine the impact of spending cuts resulting from government prescribed austerity measures on opioid-related hospitalisations and mortality, thereby expanding on existing evidence suggesting a countercyclical relationship with macroeconomic performance. We take advantage of the variation in spending cuts passed down from central government to local authorities since 2010, with reductions in budgets of up to fifty percent in some areas resulting in the rescaling of vital public services. Longitudinal panel data methods are used to analyse a comprehensive, linked dataset that combines information from spending records, official death registry data and large administrative health care data for 152 local authorities (i.e., unitary authorities and county councils) in England between April 2010 and March 2017. A total of 280,827 people experienced a hospital admission in the English National Health Service because of an opioid overdose and 14,700 people died from opioids across the study period. Local authorities that experienced largest spending cuts also saw largest increases in opioid abuse. Interactions between changes in unemployment and spending items for welfare programmes show evidence about the importance for governments to protect populations from social-risk effects at times of deteriorating macroeconomic performance. Our study carries important lessons for countries aiming to address high rates of opioid abuse, including the United States, Canada and Sweden.

The NHS: what are the UK's political parties promising?

Has traditional medicine had its day? The need to redefine academic medicine

SummaryBackgroundMeasurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).MethodsWe used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.FindingsThe highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9–78·6) for females and 72·0 years (68·8–75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0–49·5]) and for males was in Lesotho (41·5 years [39·0–44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97–6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74–6·27) for males and 6·49 years (6·08–6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61–1·93) for males and 1·96 years (1·69–2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (–2·3% [–5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.InterpretationAt a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.FundingBill & Melinda Gates Foundation.

The health expectancy of Irish Travellers, a disadvantaged indigenous minority group in Ireland has not been previously estimated. This study aimed to examine health expectancy inequalities between Irish Travellers and the general population. We used Sullivan's life table method to construct healthy life expectancy (HLE) and disability-free life expectancy (DFLE). The All-Ireland Traveller Health Study provided Irish Traveller population's mortality and health data. Vital registration, census and comparable national survey health data were used for the general population. We calculated the absolute and relative life expectancy, HLE and DFLE gaps between Irish Travellers and the general population and decomposed the HLE and DFLE gaps into mortality and morbidity contributions. Irish Travellers had consistently lower HLE and DFLE than the general population. The health expectancy gap displayed notable age and gender variations and was wider than the life expectancy gap. Mortality contributed more than morbidity to the health expectancy gap in men but not in women. This study illustrated the true extent of health inequalities experienced by an indigenous minority in Europe, clarifying the importance of reducing the burden of non-fatal disabling conditions for addressing these inequalities. The health expectancy measure used has application for other similar indigenous minorities elsewhere.