Excess Winter Research Articles

Readjusting the political thermostat: fuel poverty and human rights in the UK

Fuel poverty − the inability to afford adequate warmth in the home − is a widespread problem across the UK. Cold, damp homes are detrimental to human health and contribute to thousands of ‘excess winter deaths’ every year. This article analyses fuel poverty from a human rights perspective – asking whether it engages human rights protections. It first discusses the definition, scale and health impacts of the problem. Second, it explores the relationship between fuel poverty and the rights contained within the European Convention on Human Rights, the International Covenant on Economic, Social and Cultural Rights and the European Social Charter. It concludes that fuel poverty readily engages rights to adequate housing, food and health; and certain civil and political rights in extreme circumstances. It discusses the legal implications of these findings for fuel poverty policy, arguing for a ‘human rights approach’ to tackling the problem. These conclusions focus on the particularly drastic fuel poverty situation in the UK, but can also be applied globally to the various nations where citizens suffer similar problems and extend to the wider debate on the relationship between poverty and human rights.

Excess winter deaths in 30 European countries 1980-2013: a critical review of methods.

Background: Extreme temperatures (both excess heat and excess cold) are associated with elevated mortality risk. Methods and Results: This paper reviews historical data on cold-related deaths in Europe (1980 ? 2013). It outlines the classic ?excess winter deaths? methodology used to estimate cold-related mortality, and explores the inaccuracies which are associated with this generic estimation method: it yields relatively accurate estimates of the actual public health impacts of cold temperatures in only 2 of 30 European countries. This is an issue of concern, given the prominent role of excess winter deaths monitoring in public health policymaking and research. An alternative estimation method is proposed, based on heating degree days, which could yield more accurate estimations of the public health implications of cold weather in Europe, and how these vary across different countries. Conclusions: Further research is needed to scrutinise core assumptions underlying EWD methodology, particularly as to whether it has equal validity for estimating public health impacts across the widely diverse climatic conditions which prevail across Europe. In the mean time, given data on heating degree days are freely available for European countries, it is recommended that this approach replace the conventional methodology.

Fuel poverty, excess winter deaths, and energy costs in Vermont: Burdensome for whom?

Energy, whether from electricity, natural gas, heating oil, propane, kerosene, or wood, is essential for the well-being of many Americans, yet those who spend more than 10 percent of their income of energy services can be considered “fuel poor.” This study assesses the extent and severity of fuel poverty in Vermont. It analyzes energy burdens in Vermont by household income deciles, using data from the Census Bureau's American Community Survey. Approximately 71,000 people suffered from fuel poverty in Vermont in 2000, and in 2012 the number rose to 125,000, or one in five Vermonters. Startlingly, fuel poverty grew 76 percent during this period. Excess winter deaths, caused potentially by fuel poverty, kill more Vermonters each year than car crashes. The article then provides 12 policy recommendations based on a small sample of elite semi-structured research interviews. These include suggestions that the Vermont legislature better fund investments in weatherization among low-income households; that community groups and social service agencies scale up the training of energy efficiency coaches; that state agencies endorse improvements in housing efficiency and appropriate fuel switching; and that utilities and fuel providers offer extra assistance for disconnected households and allow for on-bill financing of efficiency improvements.

Influenza-like illness, deaths and health care costs

British Journal of Healthcare ManagementVol. 21, No. 12 Money MattersInfluenza-like illness, deaths and health care costsRod JonesRod JonesSearch for more papers by this authorRod JonesPublished Online:14 Dec 2015https://doi.org/10.12968/bjhc.2015.21.12.587AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Ellis J, Galiano M, Pebody R, et al. (2011) Virological analysis of fatal influenza cases in the United Kingdom during the early wave of influenza in winter 2010/11. Euro Surveil 16(1): Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19760 Google ScholarHealth Protection Agency (2010) Weekly national influenza report, 08 January 2010 (week 01). Available at: http://webarchive.nationalarchives.gov.uk/20140714084352/ http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1262704894811 Google ScholarJones R (2013) Analysing excess winter mortality: 2012/13. BJHCM 19(12): 601–5 Google ScholarJones R (2014a) Infectious-like Spread of an Agent Leading to Increased Medical Admissions and Deaths in Wigan (England), during 2011 and 2012. Brit J Med Res 4(28): 4723–41 Crossref, Google ScholarJones R (2014b) A study of an unexplained and large increase in respiratory deaths in England and Wales: is the pattern of diagnoses consistent with the potential involvement of cytomegalovirus? Brit J Med Medical Res 4(33): 5179–92 Crossref, Google ScholarJones R (2015a) A previously uncharacterized infectious-like event leading to spatial spread of deaths across England and Wales: Characteristics of the most recent event and a time series for past events. Brit J Med Medical Res 5(11): 1361–80 Crossref, Google ScholarJones R (2015b) Unexpected and Disruptive Changes in Admissions Associated with an Infectious-like Event Experienced at a Hospital in Berkshire, England around May of 2012. Brit J Med Medical Res 6(1): 56–76 Crossref, Google ScholarJones R (2015c) Recurring outbreaks of an infection apparently targeting immune function, and consequent unprecedented growth in medical admission and costs in the United Kingdom: A Review. Brit J Med Medical Res 6(8): 735–70 Crossref, Google ScholarJones R (2015d) Are emergency admissions contagious? BJHCM 21(5): 227–35 Google ScholarJones R (2015e) Unexpected increase in deaths from Alzheimer's, dementia and other neurological disorders in England and Wales during 2012 and 2013. J Neuroinfectious Dis 6: 172 Crossref, Google ScholarJones R (2015f) Small area spread and step-like changes in emergency medical admissions in response to an apparently new type of infectious event. Fractal Geometry and Nonlinear Analysis in Medicine and Biology 1(2): 42–54 Crossref, Google ScholarJones R (2016) Is cytomegalovirus involved in recurring periods of higher than expected death and medical admissions, occurring as clustered outbreaks in the northern and southern hemispheres? Brit J Med Medical Res 11(2): 1–31 Crossref, Google ScholarJones R, Goldeck D (2014) Unexpected and unexplained increase in death due to neurological disorders in 2012 in England and Wales: Is cytomegalovirus implicated? Medical Hypotheses 83(1): 25–31 Crossref, Google ScholarJones R, Beauchant S (2015) Spread of a new type of infectious condition across Berkshire in England between June 2011 and March 2013: Effect on medical emergency admissions. Brit J Med Medical Res 6(1): 126–48 Crossref, Google ScholarOffice for National Statistics (2015) Excess Winter Mortality in England and Wales 2014/15. Available at: www.ons.gov.uk/ons/rel/subnational-health2/excess-winter-mortality-in-england-and-wales/2014-15--provisional--and-2013-14--final-/index.html Google ScholarPublic Health England (2015) PHE Weekly National Influenza Report Summary of UK surveillance of influenza and other seasonal respiratory illnesses 22 January 2015–Week 4 report (up to week 3 data). Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/397454/Weekly_report_current_week_4x.pdf Google Scholar FiguresReferencesRelatedDetails 2 December 2015Volume 21Issue 12ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 14 December 2015 Published in print 2 December 2015 Information© MA Healthcare LimitedPDF download

Excess winter mortality associated with Alzheimer’s Disease and related dementias in the UK: A case for energy justice

For more than 25 years, excess winter deaths (EWDs) have been associated with adverse respiratory and cardiovascular events. More recently, an association between EWDs and a new spectrum of morbidity has been noted by the Office for National Statistics (ONS) for England and Wales: since at least 2009, a high prevalence of excess winter mortality has also been evident among people living with Alzheimer’s Disease and related dementias (ADRD). In the present study, excess winter mortality data for all of the UK (England, Wales, Scotland and Northern Ireland) are analysed, using a longer time series (22 years). Results corroborate ONS findings related to elevated risk of death during winter for people living with ADRD. Seasonal effects have been sustained throughout the 22 year period, and people with ADRD emerge as being at greater risk of a winter death than people with cardiovascular conditions. Establishing the reasons for such pronounced seasonal mortality patterns among people with ADRD could help ensure better energy justice for people living with the severe mental impairments imposed by these conditions, guiding more effective delivery of energy efficiency and health services to people living with this increasingly prevalent disease spectrum.

'Winter mortality, temperature and influenza' Revisiting Curwen and Devis after a quarter of a century

Objectives: to update the still quoted 25-year-old finding that a drop in winter temperature by 1 oC below its mean is associated with 8,000 excess winter deaths in England and Wales. Methods: time-series regression of excess winter deaths between 1950/1 and 2011/12 on mean outside temperature, influenza and pneumonia deaths and a secular trend. Results: we find that a 1 oC decrease in winter temperature below its mean is associated with 5,100 excess winter deaths. Excess winter mortality has been falling on average by approximately 580 deaths per year. Conclusions: Our revised estimates should supersede Curwen and Devis’s in academic and official publications. Notwithstanding there has been some mitigation in the effects of winter temperature on mortality over the last 60 years, excess winter mortality - given its magnitude- should still be a major source of public health concern in England and Wales. Jose IPARRAGUIRRE, Chief Economist, Age UK, London, United Kingdom, and Universidad de Moron, Buenos Aires, Argentina. London, United Kingdom. E-mail: jose.iparraguirre@ageuk.org.uk . James GOODWIN, Head of Research Department in Age UK, London, United Kingdom.

Urban interventions: understanding health co-benefits

Improving aspects of the built environment, such as retrofitting housing and designing transport options that encourage active journeys (cycling and walking), can have significant and demonstrable impacts on health and well-being. Policies that have primary goals such as improving energy efficiency can have important measureable co-benefits for health and well-being, as well as climate change mitigation. The authors carried out two community housing trials to measure the benefits of installing insulation and effective heating on households' health and well-being. These trials have shown that these energy efficiency projects increase health and well-being, reduce hospitalisations and excess winter mortality, and at the same time reduce carbon dioxide emissions. In a third trial, they remediated injury hazards in houses, significantly reducing the household injury rate. Using a quasi-experimental study, the authors evaluated the impact of retrofitting infrastructure to increase cycling and walking. This showed that the distance from housing to the new infrastructure was an important explanatory factor for positive changes in choice of modes of travel. Distance of housing from school was also an important factor in whether children walked or cycled to school. In conclusion, retrofitting urban and suburban infrastructure can increase health and well-being, while reducing carbon dioxide emissions.

Winter season mortality: will climate warming bring benefits?

Extreme heat events are associated with spikes in mortality, yet death rates are on average highest during the coldest months of the year. Under the assumption that most winter excess mortality is due to cold temperature, many previous studies have concluded that winter mortality will substantially decline in a warming climate. We analyzed whether and to what extent cold temperatures are associated with excess winter mortality across multiple cities and over multiple years within individual cities, using daily temperature and mortality data from 36 US cities (1985–2006) and 3 French cities (1971–2007). Comparing across cities, we found that excess winter mortality did not depend on seasonal temperature range, and was no lower in warmer vs. colder cities, suggesting that temperature is not a key driver of winter excess mortality. Using regression models within monthly strata, we found that variability in daily mortality within cities was not strongly influenced by winter temperature. Finally we found that inadequate control for seasonality in analyses of the effects of cold temperatures led to spuriously large assumed cold effects, and erroneous attribution of winter mortality to cold temperatures. Our findings suggest that reductions in cold-related mortality under warming climate may be much smaller than some have assumed. This should be of interest to researchers and policy makers concerned with projecting future health effects of climate change and developing relevant adaptation strategies.

Excess winter deaths caused by cardiovascular diseases are associated with both mild winter temperature and socio-economic inequalities in the U.S.

a University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA 94158, USA b University of California, Berkeley, Department of Environmental Science, Policy, and Management, Berkeley, CA 94720, USA c University of Lausanne, Institute of Social and Preventive Medicine, 1010 Lausanne, Switzerland d University of Lausanne, Institute of History of Medicine and Public Health, 1007 Lausanne, Switzerland

Excess winter cardiovascular morbidity in Ivanovo Region in 2009-2013 years

Chronic non-infectious diseases are characterized by irregular morbidity and mortality throughout a year. Aim. To study excess cardiovascular morbidity during winter in Ivanovo Region in 2009-2013 years. Material and methods. Excess winter morbidity index (EWMI) was calculated using special formula. The incidence of cardiovascular diseases (CVDs) was determined according to the data from the medical information-analytic center of Ivanovo Region. The index was calculated for CVDs in general, for arterial hypertension (HT) and for acute forms of CVDs (acute myocardial infarction and stroke). Results. The mean EWMI for CVDs for 5 years of the follow-up made up to 77.2% and was higher in women than in men (80% vs 69.5%, respectively). People of working age had lower excess winter morbidity than the population older than working age (53.1% and 88%, respectively). EWMI for CVDs had significant variability and ranged from 29.0% (2013 year) to 81.1% (2010 year) in men and from 25.2% to 82.9% in women in the same years. In general, the 5-year mean EWMI for HT was 72.7%; it was higher in men than in women in most of the analyzed years of follow-up. We had revealed the heterogeneity of the EWMI for HT during the analyzed period in each analyzed group (the minimal values were found in 2011 after the heat wave in 2010). EWMI for myocardial infarction demonstrated excess winter morbidity, men and women had in general similar indices (31.0% and 28.4%, respectively), but it was higher in people of working age as compared with the older ones. This index had a wide range of values. In case of stroke we had revealed no excess winter morbidity; this index was equal throughout a year. Conclusion. The influence on excess winter morbidity can result in the reduction of cardiovascular morbidity and mortality due to the decreased effect of risk factors; it would also optimize a load on healthcare system, the season irregularity of which must be taken into account when planning a work of medical centers.

SEASONAL MORTALITY PATTERNS DUE TO DISEASES OF THE CIRCULATORY SYSTEM IN PORTUGAL

Exposure to cold weather has negative consequences on human health. Studies have been showing that the seasonality of mortality has an evident peak during winter months in European countries. However, the highest increases in mortality are registered in countries with mild winters. According to several studies winter deaths seem to be associated with low socioeconomic conditions. The main aims of this study are to identify the trends of mortality due to diseases of the circulatory system and excess winter deaths in Portugal and to assess the geographical pattern of seasonal mortality. In the 20 years under analyses, mortality due to diseases of the circulatory system increased 38% during winter months when compared to the non-winter period. Important regional disparities were found, the Excess Winter Death index ranged from 21% to 48%, the central regions tend to have better results. Our results indicate that although circulatory mortality is significantly decreasing in Portugal, the vulnerability to seasonal cold weather remains as an important public health issue. These findings suggest that the exposure to cold weather is an important determinant of cardiovascular diseases that is still neglected in Portugal.

Contribution of respiratory tract infections to child deaths: a data linkage study.

BackgroundRespiratory tract infections (RTIs) are an important cause of death in children, and often contribute to the terminal decline in children with chronic conditions. RTIs are often underrecorded as the underlying cause of death; therefore the overall contribution of RTIs to child deaths and the potential preventability of RTI-related deaths have not been adequately quantified.MethodsWe analysed deaths in children resident in England who died of non-injury causes aged 28 days to 18 years between 2001 and 2010 using death certificates linked to a longitudinal hospital admission database. We defined deaths as RTI-related if RTIs or other respiratory conditions were recorded on death certificates or linked hospital records up to 30 days before death. We examined trends in mortality by age group, year and season (winter or summer) and determined the winter excess of RTI-related deaths using rate differencing techniques. We estimated the proportion of RTI-related deaths in children with chronic conditions.Results22.4% (5039/22509) of child deaths were RTI-related. RTI-related deaths declined by 2.3% per year in infants aged 28 to 364 days between 2001 and 2010. No decline was observed for older children. On average there were 161 winter excess RTI-related deaths annually, accounting for 32% of all RTI-related deaths. 89.0% of children with RTI-related deaths had at least one chronic condition; neurological conditions were the most prevalent.ConclusionsRTI-related deaths have not declined in the last decade except in infants. Targeted strategies to prevent the winter excess of RTIs and to treat RTIs in children, particularly children with chronic conditions, may reduce RTI-related deaths.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1191) contains supplementary material, which is available to authorized users.

Excess Winter Mortality in Japan: Variation across Age Groups among the Population Aged 65 Years Old and Above

Background: There is debate about whether excess winter deaths (EWD) decline in temperate countries as winters warm. While most populations in the world are now experiencing aging and older people are more vulnerable to cold temperatures, the effect of increasing age at death among the older (65+ years) population on EWD has been little researched to date. Aim: We examined whether a higher age at death is associated with higher EWD in Japan. Methods: Individual death records (N=7,191,868) of Japanese males and females who died during the years 2001-2010 at ages 65+ years, obtained from the Japanese Ministry of Health, Labor and Welfare, were used for analyses. Coefficients of seasonal variation in mortality (CSVM) for each prefecture (N=47), sex, and age group (65-74, 75- 84, and 85+ years old) were calculated as EWD [(observed winter deaths) minus (expected winter deaths)] divided by (expected winter deaths). Observed winter deaths were calculated as the total number of deaths in December through to the end of March; while expected winter deaths were calculated as half of the total number of deaths in April to November. Results: The mean (95%CI) CSVM were 0.13 (0.12-0.13) for males and 0.12 (0.11- 0.13) for females aged 65-74; 0.15 (0.14-0.16) for males and 0.18 (0.17-0.19) for females aged 75-84; and 0.22 (0.21-0.24) for males and 0.21 (0.19-0.22) for females aged 85+ years old. While older age categories were associated with higher CSVM in each prefecture, significant variation in the CSVM was observed across prefectures with no clear regional pattern, which suggests that factors other than climatic conditions and population age structure are affecting seasonal mortality patterns. Conclusions: As populations age, EWD may become more evident. Acknowledgements: Development of a Seamless Chemical Assimilation System and its Application for Atmospheric Environmental Materials (SALSA); the Research Program on Climate Change Adaptation (RECCA).

Association of vitamin D deficiency with severity of acute respiratory infection: A case-control study in New Zealand children

Background: Acute respiratory infections (ARI) are a major source of childhood morbidity and excess winter hospitalisations. Vitamin D modulates innate immunity with recent associations demonstrated between vitamin D deficiency and several respiratory illnesses. Objective: We evaluate the association of blood 25(OH)D 3 with ARI severity in early childhood, hypothesising that children hospitalised with ARI have lower levels of vitamin D. Methods: We conducted an unmatched case-control study of children aged 3 was collected by finger or heel prick as dried blood spots and analysed by LC-MS/MS. Results: 25(OH)D 3 was obtained in 469 children (227 cases, 242 controls) with levels (median, interquartile range) of 48 (24-65) nmol/L among cases and 52 (31-67) nmol/L among controls. Only 74 (16%) children had levels ≥75nmol/L. 60 (26%) cases and 42 (17%) controls were deficient (25(OH)D 3 levels Conclusion: Vitamin D deficiency was more frequent among children hospitalized for ARI, as compared to those with outpatient ARI. Vitamin D status may contribute to ARI severity amongst NZ children.

Have winter fuel payments reduced excess winter mortality in England and Wales?

The historical series of excess winter mortality (EWM) in England and Wales presents a negative trend. Winter fuel payments (WFPs) are the most important benefits for people aged 65 or over directly related to Winter Mortality in the UK. This study presents a time series analysis of the direct effect of WFPs on EWM in England and Wales. We find a significant structural break in trend and volatility in the EWM series in England and Wales in 1999-2000. After controlling for a number of covariates, an ARIMA-X model finds that WFPs can account for almost half of the reduction in EWM in England and Wales since 1999/2000. Almost half of the reduction in EWM since 1999/2000 is attributable to WFPs.

Affordable warmth interventions in North Lancashire: winner of the post award 'best for visual impact' at Public Health England 2013 annual conference.

In 2012, Lancashire County Council launched a programme to improve public health, by reducing hospital admissions, and to decrease excess winter illness/ deaths among vulnerable households at risk of severe cold in Lancaster, Wyre and Fylde. Interventions included providing practical help and information together with preventative and remedial support services.Local needs assessments identified vulnerable groups, and services were commissioned to build their resilience to cold weather. Public health messages were communicated and immediate advice and practical support services were provided to the isolated and vulnerable throughout the winter. The project ensured that more long term sustainable measures are in place to protect those most vulnerable to the cold. As a result strong partnerships have been created for the future with several agencies. These include: District and City Councils; Care and Repair Wyre and Fylde; Home Improvement Agency Lancaster; Citizens Advice Bureaux; Age UK Lancashire; LESS Community Interest Company; North West Ambulance Service; Groundworks and New Progress Housing; Lancashire Fire and Rescue Service; Energy Inform; Food Banks; Help Direct; and Lifeline Pendant Alarms.INTERVENTIONThe programme initially used funds made available for local authorities to bid for through the Department of Health's 2011/12 Warm Homes Healthy People (WHHP) initiative. As funding was announced in December when winter was already upon us, there was little time for planning. There was also no requirement to monitor or evaluate the intervention.Despite this, North Lancashire monitored the interventions provided to support some of the vulnerable members of the community and found evidence of partnership working and benefits to the local population from the interventions delivered with WHHP money. This evidence prompted NHS North Lancashire to further invest approximately £150,000 in projects across the Primary Care Trust (PCT) footprint by securing significant funding for Affordable Warmth. Therefore, for the first time it was possible to plan ahead in 2012/13 prior to the winter months and offer preventative up-stream measures, rather than taking the usual reactive approach. A referral criterion was set identifying Care and Repair and the Home Improvement Agency as the single points of access for front line agencies. Historically, referrals from health staffwere few in number during previous initiatives. On investigation, it was found that front line staffhad limited time to explore what measures were available or where to refer to, so they rarely did so. Providing one contact number for each locality would ensure access to support and give staffconfidence that an assessment would be carried out to determine the level of support needed. For the purpose of the project, the definition of 'vulnerable' used to ensure funding reached those whose health and wellbeing would be most affected by cold, damp living conditions is identified below as:* A person who is receiving services such as:* personal care or nursing or support to live independently in his/her own home; or* social care services;* A person who is affected by the following conditions:* learning or physical disability;* physical or mental illness, chronic or otherwise, including those receiving treatment for cancer and palliative care; or* reduction in physical or mental capacity.* A person with a disability of the type listed below:* dependency upon others in the performance of, or a requirement for assistance in the performance of, basic physical functions; or* severe impairment in the ability to communicate with others; or* A person with an impaired ability to protect him/herself from assault, abuse or neglect.When planning the second phase of the intervention funded by NHS North Lancashire, the Affordable Warmth team was able to build on lessons learnt in the first interventions of 2011/12. …

Public Health England 2013 Annual Conference: highlights and looking ahead.

Overview - Anthony Kessel and Emmeline BuckleyThe historian Dorothy Porter has described public health as collective action in relation to the health of populations. This definition de-emphasizes the contributions of professionals or particular interest groups, and instead stresses the essential collaborative nature of public health work. The sentiment of Porter's definition was at the heart of the 2013 Public Health England (PHE) Annual Conference.Held on 10 - 11th September 2013, this was the inaugural conference for PHE, the new national public health organization. As such, the meeting was oriented towards bringing together a range of partners and stakeholders from the diverse public health landscape of this country, and providing a forum to galvanize the new public health system.Over 1300 delegates attended the conference, including representatives from PHE, local authorities, NHS, universities, the voluntary sector, government departments and the many other organizations and groups that work collectively in relation to population and community health. Around 30 delegates from over 15 countries overseas were warmly welcomed. Over the two days the programme included over 40 sessions covering areas such as sexual health, social determinants, population healthcare, global health, transport and local government, unemployment and health inequalities, emerging diseases, the national vaccination programme, mental health and antimicrobial resistance. There were also more than 300 posters on display.In this edition of Perspectives we have the opportunity to present a series of brief snapshots of the days' events. The articles cover a wide range of issues including: the progress of an intervention to reduce teenage pregnancy in Hull; developing capacity in the field epidemiology workforce; and assessing environmental chemical exposures. Also included is the write-up of an award-winning poster, describing a partnership approach to preventing excess winter deaths in Lancashire.3 These papers go some way towards showcasing the breadth of expertise on display at the conference. Further examples of the work presented at the PHE conference can be found in the Royal Society for Public Health's sister journal, Public Health.Overall, the conference managed to display the strength of talent amongst those involved in public health in this country, and also exemplified the immense importance of collaboration with partners across sectors in the UK and internationally. The conference set a benchmark in terms of scientific quality as well as practical significance for public health delivery, and has provided a platform on which the second PHE conference in 2014 can build.Improving the health and wellbeing of adolescents: what can we learn from Europe and apply locally? - Ann Hoskins and Fiona BrooksThere are 7.4 million adolescents aged 10-19 living in the UK, representing 12% of the total UK population - the same proportion as the over-70s age group.1 Although considerable gains over the latter half the twentieth century have been made in terms of reductions in infant mortality and increased life expectancy for older people, adolescents have experienced relatively less improvement in their health and well-being than other age groups.2The second decade of life marks an important phase in the life course; not only do young people have to traverse important physical and developmental milestones, but they also gain greater autonomy and control over decision- making relating to health and health behaviours. Health-related behaviours established in adolescence, such as tobacco use, alcohol consumption and dietary habits and physical activity, may influence future health, with implications for long term conditions, health complaints and emotional well- being and mental health.The current generation of children entering adolescence and early adulthood also face considerable new challenges, including increasing academic expectations and uncertainties about future employment as well as changing social relationships (increasingly influenced by the presence of social media and the virtual world). …

A note of caution about the excess winter deaths measure

A note of caution about the excess winter deaths measure

Reply to 'A note of caution about the excess winter deaths measure'

Reply to 'A note of caution about the excess winter deaths measure'

Excess winter deaths in Europe: a multi-country descriptive analysis.

Winter deaths are a known health and social care challenge for many countries. A previous international comparison showed significant differences in excess winter deaths across Europe in the 1990s, with the northern countries having lower excess winter mortality than those in southern Europe. The Excess Winter Deaths Index (EWDI) is the ratio of deaths in the winter period (December to March) compared with deaths in the non-winter period. Data from the Eurostat database and national registries were used to calculate the EWDI for 31 countries in Europe across the time period 2002/2003 to 2010/2011. National EWDI values show heterogeneity, with a broad pattern of increasing EWDI values from northern to southern Europe and increasing mean winter temperature (r(2) = 0.50, P > 0.0001). Malta, Portugal, Spain, Cyprus and Belgium all had an EWDI that was statistically significantly higher than the average EWDI for the other 30 European countries. There was no clear association between country-level EWDI and the level of inter-annual variability in winter temperature across Europe. This article demonstrates the differences in EWDI that exist between European countries with implications for both research and policy. Many deaths may be avoidable as environmental, social and personal factors are known to contribute to winter mortality. We now need to work to better understand the causes of inter-country differences.