Local Authority Level In England Research Articles

The Effect of Public Tolerance towards Corruptive Behaviour on Healthcare Efficiency and Equity – The Case of the UK’s COVID-19 Vaccination Programme

Over the past four years, the COVID-19 pandemic has caused significant uncertainty, suffering, and economic disruption worldwide. Consequently, governments have faced pressure to ensure fair vaccine access while achieving vaccination targets quickly. Such challenging circumstances can create opportunities for nepotism and bribery, increasing attention to corruption risks associated with the pandemic response. This study investigates the relationship between public attitudes towards corruptive behaviour and the efficiency and equity of the UK's COVID-19 vaccination programme. It combines primary data on public tolerance towards corruptive behaviour with secondary data on the efficiency of the vaccination program at the local authority level in England and Scottland. We employ a survival analysis approach, estimating Cox Proportional Hazards Models, which examine the time taken to reach vaccination targets. Our findings suggest moderate tolerance towards nepotism/favouritism and bribery among the British public, with 28% of survey participants considering monetary bribery and 34% considering nepotism/favouritism as acceptable means to secure early vaccination access. Moreover, while public tolerance towards corruptive behaviour generally had a negative impact on the efficiency of the vaccination programme, it appears to have expedited the vaccination rollout in politically aligned local authorities governed by the Conservative and Unionist Party. However, this positive effect on efficiency appears to have come at the expense of reduced equity in vaccine distribution. These findings underscore the trade-off between efficiency and equity in vaccine distribution during public health crises, emphasising the need for health policies that balance efficiency with equity to ensure fair and effective distribution of vaccines in the future.

Bayesian spatial modelling of localised SARS-CoV-2 transmission through mobility networks across England.

In the early phases of growth, resurgent epidemic waves of SARS-CoV-2 incidence have been characterised by localised outbreaks. Therefore, understanding the geographic dispersion of emerging variants at the start of an outbreak is key for situational public health awareness. Using telecoms data, we derived mobility networks describing the movement patterns between local authorities in England, which we have used to inform the spatial structure of a Bayesian BYM2 model. Surge testing interventions can result in spatio-temporal sampling bias, and we account for this by extending the BYM2 model to include a random effect for each timepoint in a given area. Simulated-scenario modelling and real-world analyses of each variant that became dominant in England were conducted using our BYM2 model at local authority level in England. Simulated datasets were created using a stochastic metapopulation model, with the transmission rates between different areas parameterised using telecoms mobility data. Different scenarios were constructed to reproduce real-world spatial dispersion patterns that could prove challenging to inference, and we used these scenarios to understand the performance characteristics of the BYM2 model. The model performed better than unadjusted test positivity in all the simulation-scenarios, and in particular when sample sizes were small, or data was missing for geographical areas. Through the analyses of emerging variant transmission across England, we found a reduction in the early growth phase geographic clustering of later dominant variants as England became more interconnected from early 2022 and public health interventions were reduced. We have also shown the recent increased geographic spread and dominance of variants with similar mutations in the receptor binding domain, which may be indicative of convergent evolution of SARS-CoV-2 variants.

Why were there 231707 more deaths than expected in England between 2010 and 2018? An ecological analysis of mortality records.

BackgroundPolicy responses to the Global Financial Crisis emphasized wide-ranging fiscal austerity measures, many of which have been found to negatively impact health outcomes. This paper investigates change in patterns of mortality at local authority level in England (2010–11 to 2017–18) and the relation with fiscal austerity measures.MethodsData from official local authority administrative records are used to quantify the gap between observed deaths and what was anticipated in the 2010-based subnational population projections. Regression analyses are used to explore the relation between excess deaths, austerity and wider process of population change at local authority level.ResultsWe estimate 231 707 total excess deaths, the majority of which occurred since 2014–15 (89%) across the majority of local authorities (91%). Austerity is positively associated with excess deaths. For working age adults, there is a clear gradient to the impact of austerity, whereas for older adults, the impact is more uniform.ConclusionsFiscal austerity policies contributed to an excess of deaths for older people and widened social inequalities for younger populations. These results call for an end to all austerity measures and require further research into areas with the highest total excess deaths as a priority following the COVID-19 pandemic.

Potential effects of minimum unit pricing at local authority level on alcohol-attributed harms in North West and North East England: a modelling study

Background In 2018, Scotland implemented a 50p-per-unit minimum unit price for alcohol. Previous modelling estimated the impact of minimum unit pricing for England, Scotland, Wales and Northern Ireland. Decision-makers want to know the potential effects of minimum unit pricing for local authorities in England; the premise of this study is that estimated effects of minimum unit pricing would vary by locality. Objective The objective was to estimate the potential effects on mortality, hospitalisations and crime of the implementation of minimum unit pricing for alcohol at local authority level in England. Design This was an evidence synthesis, and used computer modelling using the Sheffield Alcohol Policy Model (local authority version 4.0). This study gathered evidence on local consumption of alcohol from the Health Survey for England, and gathered data on local prices paid from the Living Costs and Food Survey and from market research companies’ actual sales data. These data were linked with local harms in terms of both alcohol-attributable mortality (from the Office for National Statistics) and alcohol-attributable hospitalisations (from Hospital Episode Statistics) for 45 conditions defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. These data were examined for eight age–sex groups split by five Index of Multiple Deprivation quintiles. Alcohol-attributable crime data (Office for National Statistics police-recorded crimes and uplifts for unrecorded offences) were also analysed. Setting This study was set in 23 upper-tier local authorities in North West England, 12 upper-tier local authorities in the North East region and nine government office regions, and a national summary was conducted. Participants The participants were the population of England aged ≥ 18 years. Intervention The intervention was setting a local minimum unit price. The base case is 50p per unit of alcohol. Sensitivity analyses were undertaken using minimum unit prices of 30p, 40p, 60p and 70p per unit of alcohol. Main outcome measures The main outcome measures were changes in alcohol-attributable deaths, hospitalisations and crime. Savings in NHS costs, changes in alcohol purchasing and consumption, changes in revenue to off-trade and on-trade retailers and changes in the slope index of inequality between most and least deprived areas were also examined. Results The modelling has proved feasible at the upper-tier local authority level. The resulting estimates suggest that minimum unit pricing for alcohol at local authority level could be effective in reducing alcohol-attributable deaths, hospitalisations, NHS costs and crime. A 50p minimum unit price for alcohol at local authority level is estimated to reduce annual alcohol-related deaths in the North West region by 205, hospitalisations by 5956 (–5.5%) and crimes by 8528 (–2.5%). These estimated reductions are mostly due to the 5% of people drinking at high-risk levels (e.g. men drinking > 25 pints of beer or five bottles of wine per week, women drinking > 17 pints of beer or 3.5 bottles of wine per week, and who spend around £2500 per year currently on alcohol). Model estimates of impact are bigger in the North West and North East regions than nationally because, currently, more cheap alcohol is consumed in these regions and because there are more alcohol-related deaths and hospitalisations in these areas. A 30p minimum unit price has estimated effects that are ≈ 90% lower than those of a 50p minimum unit price, and a 40p minimum unit price has estimated effects that are ≈ 50% lower. Health inequalities are estimated to reduce with greater health gains in the deprived areas, where more cheap alcohol is purchased and where there are higher baseline harms. Limitations The approach requires synthesis of evidence from multiple sources on alcohol consumption; prices paid; and incidence of diseases, mortality and crime. Price elasticities used are from previous UK analysis of price responsiveness rather than specific to local areas. The study has not estimated ‘cross-border effects’, namely travelling to shops outside the region. Conclusions The modelling estimates suggest that minimum unit pricing for alcohol at local authority level would be an effective and well-targeted policy, reducing inequalities. Future work The Sheffield Alcohol Policy Model for Local Authorities framework could be further utilised to examine the local impact of national policies (e.g. tax changes) or local policies (e.g. licensing or identification and brief advice). As evidence emerges from the Scottish minimum unit price implementation, this will further inform estimates of impact in English localities. The methods used to estimate drinking and purchasing patterns in each local authority could also be used for other topics involving unhealthy products affecting public health, for example to estimate local smoking or high-fat, high-salt food consumption patterns. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.

Spatio-temporal model to estimate life expectancy and to detect unusual trends at the local authority level in England

ObjectivesTo estimate life expectancy at the local authority level and detect those areas that have a substantially low life expectancy after accounting for deprivation.DesignWe used registration data from the Office...

A tutorial on spatio-temporal disease risk modelling in R using Markov chain Monte Carlo simulation and the CARBayesST package

Population-level disease risk varies in space and time, and is typically estimated using aggregated disease count data relating to a set of non-overlapping areal units for multiple consecutive time periods. A large research base of statistical models and corresponding software has been developed for such data, with most analyses being undertaken in a Bayesian setting using either Markov chain Monte Carlo (MCMC) simulation or integrated nested Laplace approximations (INLA). This paper presents a tutorial for undertaking spatio-temporal disease modelling using MCMC simulation, utilising the CARBayesST package in the R software environment. The tutorial describes the complete modelling journey, starting with data input, wrangling and visualisation, before focusing on model fitting, model assessment and results presentation. It is illustrated by a new case study of pneumonia mortality at the local authority level in England, and answers important public health questions including the effect of covariate risk factors, spatio-temporal trends, and health inequalities.

Cartograms, hexograms and regular grids: Minimising misrepresentation in spatial data visualisations

The visualisation of spatial information is a powerful tool for researchers in urban analytics seeking to convey their findings to the wider research community and the public in an accessible way. Yet, even the most well-intentioned cartographer may introduce misrepresentation by mapping irregularly shaped and sized areas. This paper explores the extent to which different methods of visualising area-based data can remedy (or exacerbate) this misrepresentation by presenting results from a crowdsourced survey. Data from the 2016 European Union referendum at Local Authority level in England are visualised using four alternative methods (balanced cartogram, hexogram, hexagonal grid, square grid) and compared to a traditional choropleth map, in terms of people’s understanding of the authors’ intended message, through a crowdsourced survey questionnaire. Results indicate that mapping out original boundaries can introduce misrepresentation, which can be mitigated by using balanced cartograms and hexograms to improve the accuracy of visualisations.

Integrated transport planning in the UK: From concept to reality

This paper explores the need for new planning authority practices and structures that can accommodate new policy demands, synergies and approaches to urban management in the UK. Initially it considers recent UK government ideas on the integration of transport and land use planning, exploring how the concept has been located carefully in relation to both established and emerging debates about, for example, sustainability, mobility and structures of governance. The paper then moves on to consider the relationship between these concepts in EU transport discourse taking an example from Sweden of what an integrated urban transport policy might look like on the ground. The final section develops a model of integration and applies this analytic construct to assess integration practices and outcomes of urban mobility management at the local authority level in England. The research uncovers implementation failures including duplication of procedures, failures in communication and the lack of clear and resourced responsibilities.

A Model of Educational Outcomes at Local Authority Level, with Implications for Local Expenditure Needs

In this paper a model is presented of the determinants of selected outcomes of secondary education at local authority level in England. The purpose is to quantify the relative effects of different types of influence, particularly policy variables and socioeconomic environmental variables. This model is used to assess the feasibility and implications of applying an approach which involves an explicit goal of equalizing outcomes to the assessment of local expenditure needs. It is found that such a goal may be technically feasible, subject to a number of assumptions which should be investigated more fully. However, the redistribution of resources involved would pose considerable political difficulties.