Health Inequalities Bulletin 21 - August 2010

NHS Library and Information Service North Staffordshire
Health Inequalities Bulletin

ISSUE No: 21 – August 2010
About this Bulletin:
 Aims to draw attention to some of the key documents and reviews of research
in health inequalities that have been published in the two previous months.
 Where possible, links to the full text documents are included. If the article is in
a journal, you can contact the Health Library for a copy.
Link to request form: http://www.keele.ac.uk/depts/li/hl/illjournal.htm
[A charge of £2 per request is payable for most copies]
 If you need further assistance in obtaining any of the resources listed in the
bulletin or have other information needs, please contact the Outreach
Librarians or the Health Library, details below.
 The bulletin can be e-mailed to colleagues who may also find it useful.
 A list of websites that are checked in the production of this bulletin are listed
on the first page. Please suggest others that may be useful.
 Feedback is welcomed to inform future issues of the bulletin.
Topics reviewed
Black and Ethnic Minorities
Contact information Children and Young People
Communities and Neighbourhoods
NHS Outreach Librarians Drugs and Alcohol
Tel: 07834 115958 [please leave a message] Environment
E-mail: jayne.hickton@northstaffs.nhs.uk Housing
Inequalities
Lifestyles
Health Library Obesity
Tel: 01782 556565 Older People
Fax: 01782 556582 Partnerships
E-mail: health.library@keele.ac.uk Physical Activity
Public Health
Sexual Health
Smoking
Social Care
Teenage Pregnancy
Bulletin produced by NHS Outreach Librarians

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-1-
Black and Ethnic Minorities

Ethnicity and Inequality annual evidence update
NHS Evidence
The update considers obesity and south Asian children, cancer among BME groups –
perspective of the National Cancer Action Team, mental health, and ethnic groups and
prescribing – pharmacovigilance and genetic diversity.
http://www.library.nhs.uk/ethnicity/Page.aspx?prv=y&pagename=NKWINDEX
Ethnic inequalities in access to and outcomes of healthcare: Analysis of the Health

Survey for England
NazrooJ. et al
Journal of Epidemiology and Community Health Epub ahead of print 20/7/2009
Author‟s Conclusion: Ethnic inequalities in access to healthcare and the outcomes of care for
three conditions (hypertension, raised cholesterol and diabetes), for which treatment is largely
provided in primary care, appear to be minimal in England. While inequalities may exist for
other conditions and other health care settings, particularly internationally, the implication is
that ethnic inequalities in healthcare are minimal within NHS primary care
http://pmid.us/19622520
(Article available with Athens password)
Tackling Race Inequality: Summary of responses

IDeA
This document summarises the responses to a discussion document on improving
opportunities for black, Asian and minority ethnic people.
http://www.communities.gov.uk/publications/communities/tacklingraceinequality
Use of mental health services by minority ethnic groups in England

North East Public Health Observatory
Over the last decade, four new types of mental health care have been introduced in the
English NHS. This study examines how far these have been used in the care of minority
ethnic groups. The study was based on specially collected surveys. All PCTs reported
numbers of users of Crisis Resolution / Home Treatment (CRHT), Early Intervention in
psychosis (EI) and Assertive Outreach (AO) teams as part of the NHS Information Centre
'Omnibus' returns for the final quarter of 2008/09. At the same time, the 13 PCTs with first
wave services in the new Improving Access to Psychological Therapies (IAPT) programme
supplied reports of numbers referred to and entering services and numbers finishing
treatment and moving towards recovery.
http://www.nepho.org.uk/publications.php5?rid=782
Ethnicity and alcohol: a review of the UK literature

Joseph Rowntree Foundation
The review describes drinking levels as reported in national surveys and local research,
considers why drinking rates among ethnic groups may change over time, examines help-
seeking, support and service provision for minority ethnic groups and considers how services
are equipped to respond to the needs of minority ethnic groups.
http://www.jrf.org.uk/publications/ethnicity-alcohol-review
Back to the topics
Children and Young People

The chance of a lifetime: preventing early conduct problems and reducing crime
Sainsbury Centre for Mental Health
A very high proportion of those who have the most serious conduct problems during
childhood go on to become involved in criminal activity. This paper argues the case for greatly
increased investment in evidence-based programmes to reduce the prevalence and severity
of conduct problems in childhood.
http://www.scmh.org.uk/publications/chance_of_a_lifetime.aspx?ID=604

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Anti-social Behaviour Family Intervention Projects: Monitoring and evaluation

Department for Children, Schools and Families
This research provides information on the families referred to anti-social behaviour family
intervention projects, including the outcomes for the families following the intervention, the
referral agencies and the support and the challenge provided.
http://www.dcsf.gov.uk/research/programmeofresearch/projectinformation.cfm?projectId=158
83&type=5&resultspage=1
Statutory guidance on promoting the health and well-being of looked after children
Every Child Matters
This guidance is aimed at local authorities, SHAs and PCTs in England who have a shared
responsibility in helping to achieve Every Child Matters outcomes for looked after children.
http://publications.everychildmatters.gov.uk/default.aspx?PageFunction=productdetails&Page
Mode=publications&ProductId=DCSF-01071-2009&
Creating Better Outcomes for Children and Young People by improving the
Commissioning of Cultural Services
IDeA
This project helps to improve outcomes for children and young people through improving the
commissioning of cultural services. The research – involving twelve directors of Children and
Young People‟s Services or their representatives across four regions – indicates that cultural
services are absent from the strategic commissioning process in those areas. While there is
some excellent joint working, partnerships, grants and „spot purchasing‟ of particular services
or projects, cultural services are not routinely involved as key players in the mainstream
structures or processes of commissioning.
http://www.idea.gov.uk/idk/aio/14269000
Local Authority Child Poverty Innovation Pilot: First national evaluation report - Child
Poverty Unit
Department for Children, Schools and Families
This is the first report of a national evaluation of work on child poverty. It provides a synthesis
of the findings from ten individual local pilot evaluation reports.
http://publications.education.gov.uk/default.aspx?PageFunction=productdetails&PageMode=p
ublications&ProductId=DCSF-RR208&
Back to the topics
Communities and Neighbourhoods

Community philosophy: A project report
This three-year experiment used an approach called 'Community Philosophy' to promote
conversations and develop positive relationships between different groups of people within a
community. This report:
 draws on the examination and analysis that was part of the project's day-to-day
activity;
 captures the reflections of the project director and participants in the project;
 describes the theory behind the project, along with its activities (in the form of a
series of practice-based examples); and
 derives lessons of use to people who work in the community, especially youth and
community workers, and those with responsibility for community involvement and
organisational governance.
http://www.jrf.org.uk/publications/community-philosophy-project-report
Communities in recession

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As official figures show the UK's economy has shrunk for a record six consecutive quarters,
two new publications from JRF highlight the impact and reality of recession for people living in
disadvantaged communities.
They look at:
 what can be learned from previous recessions;
 what is happening in disadvantaged communities today; and
 what should happen now and in the coming years to rebuild and protect vulnerable
communities in future recessions.
In Communities in recession: the impact on deprived neighbourhoods, Rebecca Tunstall of
the London School of Economics focuses on evidence from past recessions and the current
one on the impact of recessions for communities.
http://www.jrf.org.uk/communities-in-recession
Work and worklessness in deprived neighbourhoods

This study contrasts policy assumptions about work and worklessness with the personal
experiences of residents living in deprived neighbourhoods. Recent policy debate has centred
on a number of claims about why people do not have jobs and the benefits of employment for
individual and family life. This report draws on detailed interviews with residents in deprived
neighbourhoods across Britain to reflect on the validity of these assumptions at a time of
recession and far-reaching welfare reform.
http://www.jrf.org.uk/publications/work-worklessness-deprived-neighbourhoods
Evaluation of the National Strategy for Neighbourhood Renewal: Final report

Communities and Local Government
This is the final report of the national evaluation of the national strategy for neighbourhood
renewal. It examines the nature and extent of neighbourhood deprivation, how conditions
have changed since the introduction of the strategy in 2001, and the factors that have
influenced those changes. It also assesses the impact and value for money of the strategy
and concludes by drawing together lessons for future policy.
http://www.communities.gov.uk/publications/communities/evaluationnationalstrategy
The New Deal for Communities Programme: Volume three - Making deprived areas
better places to live
This is the third volume of the final report of the new deal for communities evaluation. It
reviews and synthesises the evidence associated with the three place-related outcomes of
crime, community and housing and the physical environment.
http://www.communities.gov.uk/publications/communities/makingdeprivedareas
Financial Management After the Downturn

Improvement Network
A range of reports and research has been pulled together, which explore the recession‟s
impact on communities and public services, and suggests responses to mitigate its effects.
The CIPFA/SOLACE report: 'After the Downturn' is the latest addition.
http://www.improvementnetwork.gov.uk/imp/core/page.do?pageId=1111477
How strong are your neighbourhoods? A mapping tool for local authorities and their
partners
IDeA
This mapping tool should help local authorities, local strategic partnerships (LSPs) and their
partners identify existing practice within their organisations. This is as well as assessing the
strength and depth of empowerment in the neighbourhoods and localities in which they work.
It should provide the baseline, from which you can move forward on what is a complex and
challenging agenda.
http://www.idea.gov.uk/idk/core/page.do?pageId=18504713
Back to the topics

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Drugs and Alcohol

Children, young people and alcohol: how they learn and how to prevent excessive use
What influences how children and young people behave towards alcohol.
Two linked research reviews examine:
 how young people acquire their knowledge, attitudes, expectations and intentions
about alcohol, and:
 what interventions work best to prevent excessive use of alcohol.
http://www.jrf.org.uk/publications/young-people-alcohol-excessive-prevention
A systematic review of the clinical and cost-effectiveness of psychological therapy

involving family and friends in alcohol misuse or dependence
DARE
Meads C, Ting S, Dretzke J, Bayliss S.
Health Technology Assessment Reports, 2007; West Midlands Health Technology
Assessment Collaboration Report; 65: 97
Despite the review having one or two flaws, the authors' overall conclusions reflect the
evidence presented and are likely to be reliable.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12008104821
Tackling problem drug use

National Audit Office
This report into government action to tackle problem drug use has concluded that there has
been good progress in a number of areas, including an increasing number of problem drug
users in effective treatment and an increasing number leaving treatment free from
dependency. Without an evaluative framework for the Strategy as a whole, the NAO was not
able to conclude positively on value for money. However, the NAO noted that the Drug
Treatment Outcomes Research Study (DTORS) has estimated the benefit-cost ratio for drug
treatment, the largest element of spending, at 2.5 to 1 and that the programme has delivered
some significant successes.
http://www.nao.org.uk/publications/0910/problem_drug_use.aspx
Drugs research: an overview of evidence and questions for policy

In 2001 the JRF embarked upon a programme of research that explored the problem of illicit
drugs in the UK. This study gives an overview of the projects in the programme. The topics
covered include: the policing of drug possession; the domestic cultivation, purchasing and
heavy use of cannabis; non-problematic heroin use, heroin prescription and Drug
Consumption Rooms; the impact of drugs on the family; and drug testing in schools and in the
workplace.
http://www.jrf.org.uk/publications/drug-research-policy-questions
Back to the topics
Environment
Urban green nation: Building the evidence base
CABE
The report shows that if people are satisfied with local parks, they tend to be satisfied with
their council. Almost nine out of 10 people use local green spaces: they are a highly valued
service. The findings strongly suggest that investing in the quality of local parks and green
spaces is an important way to tackle inequalities in health and well-being and to improve
residents‟ perceptions of their area. However, there are disparities. People from minority
ethnic groups tend to have far less local green space (up to a staggering 11 times less) and
what little they have is of a poor quality.
www.cabe.org.uk/publications/urban-green-nation
Sustaining a Healthy Future: Taking Action on Climate Change

UK Faculty of Public Health

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In association with the NHS Sustainable Development Unit and the NHS Confederation, the
Faculty of Public Health has published a new handbook containing lots of practical advice and
information on how healthcare organisations and individuals can tackle climate change,
improve business practice and support good public health.
http://www.fph.org.uk/uploads/Sustainable_development_guide.pdf
Future Health: Sustainable places for health and well-being

Commission for Architecture and the Built Environment
This report explains how good design and planning can have a positive impact on public
health, how health trusts can cut carbon and costs by co-locating services and how designers
can influence people's well-being.
http://www.cabe.org.uk/publications/future-health
Health and Climate Change

The Lancet
A series of reports have been published by the Lancet on the health benefits of tackling
climate change. The reports call on health ministers and professionals across the world to
recognise the danger that climate change poses to health, in the run up to the UN conference
in Copenhagen in December. Key findings show that changes towards a low carbon transport
system could reduce the health impacts of urban air pollution and physical inactivity, housing
insulation can reduce deaths from both extreme cold and heat, changes in farming practice to
reduce livestock and overall meat consumption could improve health by lowering the intake of
saturated fat, and in poor countries, a reduced need to burn solid fuel indoors could have a
significant impact on child and maternal health by cutting indoor air pollution.
http://www.thelancet.com/series/health-and-climate-change
(Articles available via the Health Library)
Street cleanliness in deprived and better-off neighbourhoods

An exploration of why affluent neighbourhoods tend to have higher levels of street cleanliness
than deprived neighbourhoods and what local authorities can do to narrow this gap.
This study brings together evidence from across England and Scotland on the relationships
between street cleanliness, neighbourhood characteristics and local authority service
provision and expenditure.
http://www.jrf.org.uk/publications/street-cleanliness-neighbourhoods
Climate Change Support for Local Authorities: A directory of the national and regional
support
IDeA
A directory of the national and regional support available to support the work of local
authorities in responding to climate change
Sharing resources to tackle climate change

IDeA
Finding the human and financial resources to tackle climate change – particularly during a
period when budgetary constraints are tight – is not easy. This article looks at how local
authorities around the country are pooling resources and staff to work on climate change.
http://www.idea.gov.uk/idk/core/page.do?pageId=14111353#contents-4
Experiencing Landscapes: Capturing the cultural services and experiential qualities of

landscape
Natural England
This report examines how England‟s landscapes provide a range of „services‟ that contribute
to people‟s quality of life, including spiritual enrichment, cognitive development, reflection,
recreation and aesthetic enjoyment.
http://naturalengland.etraderstores.com/NaturalEnglandShop/NECR024
An analysis of urban transport

Cabinet Office

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This paper reviews the challenges and opportunities for transport in urban areas. It finds that
the impact of transport on the people that live and work in cities goes beyond the benefits of
mobility and the economic consequences of congestion. Poor air quality, ill health and road
accidents from transport in urban areas all impose significant additional costs on society.
http://www.cabinetoffice.gov.uk/media/307736/urban-transport.pdf
Local low-carbon economies

IDeA
Local authorities are playing a vital part in helping the nation meet statutory carbon reduction
targets. This increasingly means working with local, regional and national partners to deliver
substantial carbon savings in all sections of the economy. This section – written by Peter
Young and Andy Barron of Enviros – offers you an outline of what your council can do to help
build a local low-carbon economy.
The green information gap: mapping the nation's green spaces

CABE
There is a major gap in the national information about England‟s urban green spaces: nobody
knows how many there are, where they are, who owns them or what they are like. This makes
it difficult to co-ordinate provision, respond to changing social needs or plan for a changing
climate.
A single, shared, information resource – a kind of atlas – would help piece together the
different elements of the nation‟s green infrastructure – parks, gardens, allotments, trees,
green roofs, cemeteries, woodlands, commons, grasslands, moors and wetlands.
This is a position paper written for policymakers. It says the new resource could be part of a
wider information revolution that makes the most of our nation‟s green assets.
http://www.cabe.org.uk/publications/the-green-information-
gap?utm_medium=email&utm_source=CampaignMonitor&utm_content=889810657&utm_ca
mpaign=CABENews-
December2009+_+uhhyui&utm_term=Thegreeninformationgapmappingthenationsgreenspace
s
Grey to Green: How we shift funding and skills to green our cities
CABE
Grey to Green will fuel a debate about whether this is smart, given the dangers of climate
change and the opportunities to improve public health. It also reveals the urgent need for
more people, with the right skills, to manage the living landscape of our towns and cities. The
document provides fresh ideas and evidence, showing how we could design and manage
places in radically different ways. It will be of interest to anyone involved in greening the built
environment, but above all to the people taking decisions about where to commit public
money at a local and a national level.
http://www.cabe.org.uk/publications/grey-to-
green?utm_medium=email&utm_source=CampaignMonitor&utm_content=889810657&utm_c
ampaign=CABENews-
December2009+_+uhhyui&utm_term=GreytoGreenhowweshiftfundingandskillstogreenourcitie
s
Green spaces for health – quality as well as the quantity

IDeA
Natural England has come up with an impressive manifesto on enhanced health through use
of quality green spaces. Evidence proves that an individual‟s health improves if they live near
quality green space regardless of social grouping or economic status.
Climate change or sustainable development?

IDeA
Climate change has become a mainstream priority for local authorities. But is this being
achieved at the expense of sustainable development? The IDeA‟s Steve Waller and CAG
Consultants‟ Denny Gray examine the evidence.

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Community green: using local spaces to tackle inequality and improve health
CABE
This report examines the impact of the quality of local green spaces on the health and
wellbeing of people in six deprived and ethnically diverse areas. It shows that providing good
quality local green space is an effective way to tackle inequality. It will be of interest to
policymakers and those working in local government, social housing and the voluntary and
community sector.
http://www.cabe.org.uk/files/community-green-full-report.pdf
A successful approach to climate change

IDeA
What makes some councils more effective at tackling climate change than others? Dan
McCartney, outgoing Consultant at the IDeA, shares some insights from research based on
the experience and approach of five councils.
A clean bill of health: how councils’ environmental protection work

improves health and well-being
Lacors
Pollution is a significant factor in ill health, it reduces life expectancy and it perpetuates health
inequalities. It should be considered alongside other important health issues such as reducing
smoking, healthy eating and exercise. Councils and their partners play a crucial role in
reducing pollution, but further progress is needed to protect our communities. LACORS,
which is part of the LGA Group, has published "A clean bill of health" that summarises for
councillors, and other local decision makers, the health effects of pollution and what councils
and their partners can do to improve the health of their communities
http://www.lacors.gov.uk/lacors/upload/24597.pdf
Back to the topics
Housing
The development of social well-being in new extra care housing schemes
Extra care schemes help older people remain independent. But they also aim to provide
social opportunities that prevent residents feeling isolated.
This research, which examined how social well-being developed in 15 new-build housing
schemes, revealed the following:
 Communal facilities and a diverse range of organised activities need to be available
when schemes open as they help residents interact
 Residents involved in running social activities found it gave them ownership of their
social lives, supported their independence and encouraged others to join in
 Adequate staff time and resources to support social activities are crucial at the start
of a scheme but also over time as some residents become frailer
http://www.jrf.org.uk/publications/well-being-extra-care-schemes
Housing & Neighbourhoods Monitor: Analysis of housing and neighbourhoods trends

across the UK
The JRF has launched a new website that provides a single source of information on key
housing and neighbourhoods trends across the UK.
The website provides:
 charts of key indicators, which support understanding of how long-term trends vary
across the four nations of the UK;
 maps that assist in local, regional and national service planning by enabling people to
compare different housing and neighbourhoods concerns across the four nations and
different local areas;

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 reports that analyse and comment on the indicators and overall policy outcomes,
giving an overall picture of UK housing and neighbourhoods concerns. A UK-wide
report and findings summary has been published.
http://www.hnm.org.uk/
The SHARP study: a quantitative and qualitative evaluation of the short-term outcomes
of housing and neighbourhood renewal
Petticrew M, Kearns A, Mason P, Hoy C
BMC Public Health 2009, 9:415 (17 November 2009)
Conclusion: This study found that self-reported health changed little in the first year after
moving. Nonetheless, the quantitative and qualitative data point to improvements in the
quality of housing and of the local environment, as well as in tenant satisfaction and other
related outcomes. Further analyses will explore whether these effects are sustained, and
whether differences in health outcomes emerge at 2 years compared with the Comparison
group.
http://www.biomedcentral.com/1471-2458/9/415/abstract
Building Better Lives

Improvement Network
A report into strategic housing says councils are focused on building new homes, but should
give more attention to making the most of existing houses and flats in their area. Access the
full report 'Building Better Lives', and access a new housing markets analysis tool.
An accommodation self assessment toolkit for the Socially Excluded Adults Public
Service Agreement
This toolkit is designed to assist local housing authorities to deliver improved accommodation
outcomes for the four client groups in public service agreement 16 in partnership with
probation, children's services, adult social care, primary care trusts and other local partners,
including the voluntary sector and registered social landlords.
http://www.communities.gov.uk/publications/housing/accommodationtoolkit
Back to the topics
Inequalities
Tackling the wider social determinants of health and health inequalities: evidence from
systematic reviews
C Bambra et al
Journal of epidemiology and community health doi:10.1136/jech.2008.082743 Published
Online First 19 August 2009
Conclusion: Intervention studies which address inequalities in health are a priority area for
future public health research.
http://jech.bmj.com/content/early/2009/08/19/jech.2008.082743.full.pdf
Health inequalities in ex-coalfield and industrial communities

IDeA
This publication looks at the issue of regeneration of former coalfield areas. It asks whether
health has been overlooked in the past, and how former coalfield areas might move forward in
tackling health inequalities.
The document is targeted at elected members with a health remit, as well as council and
primary care trust (PCT) staff with a responsibility for health improvement and reducing health
inequalities. The hope is that it will act as a handy reference document on the issue and will
also spark debate and discussion about the best way forward.
http://www.idea.gov.uk/idk/aio/18036469
Inclusion Health: improving primary care for socially excluded people

Department of Health

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This is a practical guide to support PCTs in commissioning improved primary care services for
socially excluded people. It sets out the case for change by outlining the poor health
outcomes experienced by socially excluded people and (the often high costs of) their current
patterns of access to services. It supports PCTs to routinely identify the needs of socially
excluded people and assure appropriate access to high quality primary care services for
these most vulnerable groups. The guide highlights best practice case studies and identifies a
series of underlying principles and features which are present in services which successfully
meet the needs of socially excluded people.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc
e/DH_114067
Health Inequalities (HINST) Enhanced Support Programme resource manual

The Health Inequalities National Support Team has published a resource manual containing a
range of information, resources and tools, including a series of 'How to guides' and
'Masterclass reports'. The manual has been built around good practice identified so far, that
are expected to make an impact on mortality in a short timescale if delivered at a sufficient
scale.
e/DH_115113
Inclusion Health: Improving the way we meet the primary healthcare needs of the
socially excluded
Cabinet Office
This study outlines how improvements in health care for the most excluded groups in society
can be accelerated to ensure high quality services are available to all. The joint study by the
Department for Health and the Social Exclusion Task Force in the Cabinet Office examined
how well the primary health care needs of vulnerable groups are being met. It concluded that
considerable progress has been made, but also highlighted that socially excluded groups
often have complex needs and require a sophisticated and flexible response from service
providers. ‟Inclusion Health‟ provides a framework for driving a step-change in outcomes for
socially excluded groups, launching an agenda that addresses the specific challenges of
working with them, while going with the grain of wider health reforms. It is supported by an
evidence pack which brings together existing and new data and analysis on the health needs
and outcomes of socially excluded groups, and highlights the challenges and opportunities
within this field.
http://www.cabinetoffice.gov.uk/media/346571/inclusion-health.pdf
Health Inequalities Intervention Toolkit

Association of Public Health Observatories and the Department of Health
This Toolkit is designed to assist evidence-based local service planning and commissioning.
This online resource draws together key data and modelling on health indicators and includes
tools on life expectancy, infant mortality and commissioning interventions.
http://www.lho.org.uk/LHO_Topics/Analytic_Tools/HealthInequalitiesInterventionToolkit.aspx
Healthy balance: a review of public health performance and spending

Audit Commission
This briefing estimates that £21 billion of NHS funds has been allocated in 2009/10 on the
basis of health inequalities. Despite the health of the nation improving overall, health
inequalities has proved a difficult area to address. The report highlights some of the variation
in success among different localities, particularly for teenage pregnancies. Despite the sums
of money allocated, it is not always clear how much has been spent on improving health
inequalities and what the impact has been. It is hard to see an obvious link between spending
and improvement, or get any clear view of value for money.
http://www.audit-
commission.gov.uk/health/nationalstudies/primarycare/Pages/healthybalance_copy.aspx
Monitoring poverty and social exclusion 2009

New Policy Institute and Joseph Rowntree Foundation

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This report uses official government data and is built around a set of 50 indicators. The
analysis covers a wide range of issues, ranging from low income, worklessness and debt, to
ill-health, poor education and problems in communities. The report shows that, whilst the
recession has certainly had an impact, several key indicators, particularly regarding low
income, unemployment and debt, were already getting worse, well before the recession
began. In addition, many indicators have improved, notably in health and education.
http://www.jrf.org.uk/publications/monitoring-poverty-2009
Tackling health inequalities: 2006-08 policy and data update for the 2010 national target
This document provides an update on progress to meet the health inequalities national target
to reduce the gap as measured by infant mortality and life expectancy, by 10% by 2010. It
includes an assessment of whether the 70 spearhead area local authorities, which map to 62
PCTs, are on track to meet the life expectancy target.
e/DH_109469
Improving partnership working to reduce health inequalities

King‟s Fund
What general principles could help the NHS to facilitate and create better partnerships to help
reduce health inequalities? Tammy Boyce and Professor David Hunter discuss the
possibilities.
http://www.kingsfund.org.uk/what_we_do/articles/improving.html
The social determinants of health and the role of local government

IDeA
This collection of articles assesses what local government can do to tackle the social
conditions that lead to health inequalities. Written by distinguished practitioners and
academics, the publication builds on the recent Marmot Review report, 'Fair Society, Healthy
Lives'.
Healthy Communities Direction of Travel Survey results 2009

IDeA
In 2008 Ipsos MORI carried out a survey of local authority chief executives. It aimed to
understand how councils are involved in tackling health inequalities and improving the health
of local communities. Read the 2009 survey, discover how views have changed and find out
what chief executives believe the future challenges to be.
Fair Society, Healthy Lives (Marmot Review)

University College London
A report has been published on the review by Professor Sir Michael Marmot of University
College London. The aim of the review was to propose an evidence based strategy for
reducing health inequalities from 2010. The strategy includes policies and interventions that
address the social determinants of health inequalities.
http://www.marmotreview.org/
Taking forward the role of council regulators

IDeA
The following sections aim to facilitate a greater contribution by local authority regulatory
services (LARS) to the health of the communities they serve. You will find practical advice
through a number of case studies based on the views and experience of LARS staff.
These illustrate the breadth and depth of the role they can play in improving health and
addressing the causes of poor health or inequalities.
Doctors role in reducing inequalities

Royal College of Physicians

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This report calls on doctors to make addressing the social determinants of health part of their
everyday medical practice, reducing where they can the inequitable burden of disease. The
report „How doctors can close the gap: tackling the social determinants of health through
culture change, advocacy and education‟ is the synthesis of the ideas and proposals to
emerge from a series of policy dialogues held at the Royal College of Physicians.
http://www.rcplondon.ac.uk/professional-Issues/Public-Health/Documents/RCP-report-how-
doctors-can-close-the-gap.pdf
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Lifestyles
Lifestyle interventions in primary care: systematic review of randomized controlled
trials
Fleming P, Godwin M
DARE
CRD Summary: The review concluded that lifestyle counselling interventions delivered in
primary care settings by primary care providers to patients at low risk of cardiovascular
disease appeared to be of marginal benefit. The authors' conclusions are sufficiently cautious
and are likely to be reliable.
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009102518
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Obesity
Obesity Annual Evidence Update

NHS Evidence
The third Annual Evidence Update on Obesity focuses on Childhood Obesity: Surveillance
and Prevention. It is an update of the evidence from March 2009 to February 2010.
http://www.library.nhs.uk/PUBLICHEALTH/ViewResource.aspx?resID=346750
The cost-effectiveness of a school-based overweight program

NHS Economic Evaluation Database
Brown H S, Perez A, Li Y P, Hoelscher D M, Kelder S H, Rivera R.
International Journal of Behavioral Nutrition and Physical Activity, 2007; 4: 47
Concluding remarks: The study was well conducted and the methods and results were well
reported. The authors' conclusions appear to be valid.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=22008000206
Treating childhood obesity through lifestyle change interventions. A briefing paper for
commissioners
National Obesity Observatory
This document aims to support commissioners by providing a brief guide to current best
available evidence on effective treatment interventions for children and young people who are
overweight or obese.
http://www.noo.org.uk/gsf.php5?f=4512&fv=4569
Obesity data briefings

National Obesity Observatory
These are key data briefings which compile up-to-date information and data about obesity
and its determinants in an easily readable format. They will be updated regularly and the
series will be expanded to cover more factors that impact on obesity.
- Adult weight
- Child weight
- Determinants of obesity: adult diet
- Determinants of obesity: child diet
- Determinants of obesity: adult physical activity
- Determinants of obesity: child physical activity

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http://www.noo.org.uk/NOO_pub/Key_data
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Older People
Older people's vision for long term care
This study examined the experiences and aspirations of older people living in residential and
nursing care homes. It highlights their ambition to increasingly influence decisions about care,
support and wider issues such as whether or not to move to a care home, what helps to
enhance their quality of life, and what is needed to promote their inclusion in care home,
family and wider community life.
http://www.jrf.org.uk/publications/older-people-vision-long-term-care
Creating a stronger information, advice and advocacy system for older people
This Solutions paper highlights recent work in Newcastle by the Quality of Life Partnership
that's developed ways of working with existing systems to make them more 'older person
friendly', efficient, and effective for all concerned.
http://www.jrf.org.uk/publications/information-advice-advocacy-for-older-people
National Evaluation of Partnerships for Older People Projects: final report

The Partnership for Older People Projects (POPP) were funded by the Department of Health
to develop services for older people, aimed at promoting their health, well-being and
independence and preventing or delaying their need for higher intensity or institutional care.
The evaluation found that a wide range of projects resulted in improved quality of life for
participants and considerable savings, as well as better local working relationships.
e/DH_111240
Under pressure: tackling the financial challenge for councils of an ageing population
Audit Commission
The report suggests that councils face the challenge of an ageing population as public
spending reduces and that most councils do not know enough about the costs of their ageing
population. They may also miss the savings that could flow from preventive services and
better work with other organisations.
http://www.audit-
commission.gov.uk/nationalstudies/localgov/underpressure/Pages/default.aspx
Supporting People in Later Life Annual Evidence Update

NHS Evidence
This update aims to provide healthcare professionals with a clear path to the most important
recent evidence about caring for older people who are experiencing difficulties with
independent living due to health problems. It includes information on acute care, residential
and supported care, primary and community care, assessment, assistive technologies and
telehealth and independent living.
http://www.library.nhs.uk/laterlife/viewResource.aspx?resid=346692&code=3bf5d4c4785c63f
356d544887baebf72
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Partnerships
LSP Improvement Tool
Improvement Network
Local strategic partnership (LSP) coordinators are being invited to access this unique online

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tool, which is designed to aid LSP performance improvement and is already being used by
118 LSPs. Read more about the tool and how to access it.
Signposting Sustainability Through CAA

Improvement Network
Sustainability is one of four underpinning themes in Comprehensive Area Assessment (CAA).
This new online resource aims to show how local authorities and their local strategic partners
can take this into account in their current and future work to improve performance and
outcomes.
Developing customer insight: practice examples

IDeA
Customer insight has many applications in local public service delivery. Here are a few
practice examples showing how some councils and their partners have developed customer
insight.
Community engagement key to Enfield's JSNA strategy

IDeA
The London Borough of Enfield has teamed up with the local primary care trust (PCT), NHS
Enfield. They have placed community engagement at the heart of their joint strategic needs
assessment (JSNA). Community leaders have described the wide-ranging exercise as “as
good as you will find anywhere”. It has resulted in a JSNA which will help transform services
and, in turn, improve the health and wellbeing of the local population.
Report on the 2009 Survey of all English Local Area Agreements: Long-term evaluation
of local area agreements and local strategic partnerships
The 2009 Survey of Local Area Agreements explores how the LAAs are helping partnerships
achieve positive outcomes for local people. The survey was conducted as part of the long-
term evaluation of local area agreements and local strategic partnerships.
http://www.communities.gov.uk/publications/localgovernment/evaluationlaalsp
Communities for Health programme

IDeA
The DH has published a new report about the programme. This includes community activities
in over 80 local authorities aimed at encouraging behaviour change and strengthening local
partnerships to tackle a wide range of key health priorities „Communities for Health: Unlocking
the energy within communities to improve health‟.
The IDeA has published an accompanying document called „Communities for Health: The
story so far...‟. The publication goes behind the scenes and gives a range of examples of local
authority involvement in the programme and explains how it has influenced their strategic
thinking about health and started to make a difference to the communities they serve.
Oneplace national overview report

The report looks at the findings from the first year of Comprehensive Area Assessment
(CAA). It is published by the six inspectorates responsible for assessing local public services
in England - the Audit Commission, Care Quality Commission, Her Majesty‟s Inspectorates of
Constabulary, Prisons and Probation, and Ofsted. The report complements local reporting of
CAA through the Oneplace website. It explains what the first year of CAA has indicated about
how well local public services are delivering national and local priorities and spending £200
billion of public money. It sets out what what helps and hinders improvement in local public
services, to guide national and local policymakers.
http://oneplace.direct.gov.uk/aboutthissite/Pages/oneplaceoverviewreport.aspx

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Leading Together Better

IDeA
During the summer of 2009, the IDeA‟s Healthy Communities programme sponsored a
research project by Shared Intelligence. This explored the nature of partnership working
between directors of public health, adults‟ services and children‟s services. It is hoped that the
report will stimulate local discussion on the nature of partnership working for health and
wellbeing and how it can be improved.
Sharing the Gain: Collaborating for Cost Effectiveness

Improvement Network
This has been written to help public service bodies take advantage of collaborative working
opportunities and reduce their costs.
Total Place: a whole area approach to public services

HM Treasury
This report sets out a new direction for local public services and new freedoms from central
control. It is based on work over the last year by 63 local authorities, 34 PCTs, 13 police
authorities and other partners, with more than 70 other local areas engaged in similar work.
Together the pilots have a population of more than 11 million people. The pilots have mapped
more than £82 billion of public spending in their areas.
http://www.hm-treasury.gov.uk/psr_total_place.htm
Partnership working and Total Place

IDeA
This provides information on the governance structures, accountabilities and work of LSPs -
because strong, robust partnerships will deliver the best outcomes for local people. The
partnership working element of the Total Place programme is also looked at.
Valuing health - Business case literature review

IDeA
This literature review summarises the available evidence and research on the financial and
non-financial impact of health improvement activity. It highlights the need for a greater focus
on the financial impact of health improvement activity on local government services. It
indicates that there are a number of areas where local authorities could expect to make
efficiency savings, including older people‟s health and independence, workforce health and
climate change and sustainability.
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Physical Activity
Cost effectiveness of community-based physical activity interventions
NHS Economic Evaluation Database (NHS EED)
Roux L et al
American Journal of Preventive Medicine 2008; 35(6): 578-588
CRD Summary: The objective was to assess the cost-effectiveness of seven interventions to
increase physical activity in an adult population aged 25 to 64 years. The authors concluded
that all the interventions assessed were cost-effective and offered good value for money.
While there were some limitations associated with the reporting of the study, in general the
methods appear to have been robust and the authors‟ conclusions seem to be appropriate
Health survey for England - trend tables and physical activity and fitness
NHS Information Centre

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The Health Survey is a series of annual surveys designed to measure health and health-
related behaviours in adults and children living in private households in England. The trend
tables focus on key changes in core topics and measurements. These include estimates of
the number, as well as the proportion, of people with a range of health related problems and
lifestyle behaviours. The 2008 Survey focused on physical activity and fitness and a second
report details the results in that area.
Trend tables: http://www.ic.nhs.uk/pubs/hse08trends
Physical activity and fitness: http://www.ic.nhs.uk/statistics-and-data-collections/health-
and-lifestyles-related-surveys/health-survey-for-england/health-survey-for-england--2008-
physical-activity-and-fitness
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Public Health
Public Health Interventions Cost-Effectiveness Database
National Library for Public Health
A new database to aid commissioners locate information on cost-effectiveness of public
health interventions is now available via the National Library for Public Health. The database
was commissioned by Health England and was jointly developed by the National Library for
Public Health and the Yorkshire & Humber Public Health Observatory health economics team.
It covers four areas of public health – obesity, physical activity, alcohol, and tobacco.
http://www.yhpho.org.uk/nphl/nphlresults.asp
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Sexual Health
Department of Health – Young people’s sexual health: the National Chlamydia
Screening Programme
National Audit Office
The report suggests that the delivery of the Government‟s programme to control chlamydia
infection in young people to date has not demonstrated value for money. There are no exact
figures available on the costs of the Programme, but the NAO estimates that around £100
million has been spent to date. PCTs have had little guidance on costs to help them deliver
the Programme efficiently and spending has varied from place to place. There has been
duplication of effort, with, for example, 45 different brands developed for the Programme in
different parts of England. Savings of £17 million could have been made in 2008-09,the NAO
estimates, if all PCTs had delivered tests for £33 (the Agency‟s calculation of an achievable
cost per test in established local programmes), rather than the average of £56 per test, in that
year.
http://www.nao.org.uk/publications/0809/young_peoples_sexual_health.aspx
Standards for the management of sexually transmitted infections (STIs)

British Association for Sexual Health and HIV
These standards provide a framework for monitoring performance which covers the core
principles of STI care, staff training, clinical assessment and management, diagnostics,
information governance, links to other services, clinical governance and the engagement of
patients and the public.
http://www.bashh.org/news/435_bashh-standards-for-the-management-of-sexually-
transmitted-infections
A national study of people over 50 living with HIV

Terrence Higgins Trust and Age UK
This study investigated the needs and concerns of older adults living with HIV. It looked at
how improved treatments are allowing people with HIV in the UK to live longer into later life
and revealed that there are high levels of uncertainty about future health and care. A full
report, exploring these issues further, will be published in Summer 2010.
http://www.jrf.org.uk/publications/over-50-living-with-HIV

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Smoking
Mobile phone-based interventions for smoking cessation
Whittaker R, Borland R, Bullen C, Lin RB, McRobbie H, Rodgers A.
Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006611. DOI:
10.1002/14651858.CD006611.pub2
Authors' conclusions: The current evidence shows no effect of mobile phone-based smoking
cessation interventions on long-term outcome. While short-term results are positive, more
rigorous studies of the long-term effects of mobile phone-based smoking cessation
interventions are needed.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006611/pdf_fs.html
A smokefree future: a comprehensive tobacco control strategy for England

This strategy establishes a vision of eradicating tobacco harms and creating a smokefree
future, so that the Department of Health can support people to live healthier and longer lives.
The strategy follows on from a successful public consultation in 2008 on the future of tobacco
control, which drew nearly 100,000 individual responses.
e/DH_111749
Measuring smoking prevalence in local populations

Association of Public Health Observatories
This is the seventh in a series of technical briefings produced by the APHO, designed to
support public health practitioners and analysts and to promote the use of public health
intelligence in decision making. This briefing provides brief overviews of potentially useful
sources of local-level smoking data, option appraisals for local-level surveillance of smoking
and pointers to help local organisations meet their local smoking prevalence information
needs.
http://www.apho.org.uk/resource/item.aspx?RID=87192
Supplementary Paper – Other potential sources of smoking-related data:
http://www.apho.org.uk/resource/item.aspx?RID=87076
Back to the topics
Social Care
Identifying a fairer system for funding adult social care
The recent Green Paper shows that the Government has moved on from previous statements
on adult social care – but it still lacks important detail, particularly on funding options.
In this Viewpoint, Justin Keen (Professor of Health Politics) and David Bell (Professor of
Economics) evaluate the Paper and ask the following questions:
 Is the Government taking steps to ensure that arrangements for the care and
support of older people are fair?
 Is the Green Paper detailed enough to determine whether people on different
incomes may 'win' or 'lose' under any new set of proposals?
http://www.jrf.org.uk/publications/fairer-funding-adult-care
Means to an End: Joint financing across health and social care

Audit Commission
This report reviews the joint financing and integrated care arrangements between NHS bodies
and councils with adult social care responsibilities.
http://www.audit-
commission.gov.uk/nationalstudies/health/financialmanagement/Pages/91029meanstoanend.
aspx

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Use of resources in adult social care – a guide for local authorities

This guide aims to stimulate discussion and debate for local authorities on how to commission
and shape services for tomorrow by making best use of resources.
http://www.dhcarenetworks.org.uk/_library/Resources/Personalisation/Personalisation_advice
/298683_Uses_of_Resources.pdf
Social Care Third Report of Session 2009–10

House of Commons Health Committee
The report sets out the results of an inquiry into the future of social care services. It looked at
options for future funding of long-term residential and domiciliary care for older people and
people with physical or learning disabilities; personalisation of social care services; and more
effective, consistent and user-friendly social care services. The Committee comments that it
would have liked to see all the political parties come together to map out sustainable reform,
instead of indulging in pre-election point-scoring. It concludes there is still an opportunity,
though, in advance of the demographic challenges to come, to reform social care, achieving
consensus and creating a lasting solution.
Volume 1: Report:
http://www.publications.parliament.uk/pa/cm200910/cmselect/cmhealth/22/22.pdf
Voume 2: Oral and written evidence:
http://www.publications.parliament.uk/pa/cm200910/cmselect/cmhealth/22/22ii.pdf
Adult social care

Care Quality Commission
The CQC has published four reports on the quality of adult social care in England. Findings
from the report include: councils are improving their ratings overall, however the assessment
highlights concerns that are real and affect people's lives; ratings for providers have also
improved, however one in six providers are only "poor" or "adequate"; councils must help get
rid of poor quality care by purchasing from providers more effectively, particularly in some
areas; CQC has identified councils where improvements in adult social care must be a
priority; and CQC will be vigilant about spotting the impact of the economic downturn on
people's access to social care CQC is raising the bar on councils and providers.
http://www.cqc.org.uk//newsandevents/pressreleases.cfm?cit_id=35578&FAArea1=customWi
dgets.content_view_1&usecache=false
Building the National Care Service

The Department of Health
This White Paper sets out the Government's proposals to build a comprehensive National
Care Service for all adults in England with an eligible care need, free when they need it.
e/DH_114922
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Teenage Pregnancy
Interventions for preventing unintended pregnancies among adolescents
Oringanje C, Meremikwu MM, Eko H, Esu E, Meremikwu A, Ehiri JE.
Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD005215. DOI:
10.1002/14651858.CD005215.pub2.
Authors' conclusions: Combination of educational and contraceptive interventions appears to
reduce unintended pregnancy among adolescents. Evidence for program effects on
biological measures is limited. The variability in study populations, interventions and
outcomes of included trials, and the paucity of studies directly comparing different
interventions preclude a definitive conclusion regarding which type of intervention is most
effective.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005215/pdf_fs.html

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Teenage pregnancy and social disadvantage: systematic review integrating controlled

trials and qualitative studies
DARE
Harden A, Brunton G, Fletcher A, Oakley A.
BMJ 2009; 339:b4254
CRD Summary: This review concluded that the effectiveness of early childhood interventions
and youth development programmes for reducing unintended teenage pregnancy was
supported by a small, but sound, evidence base. This was a generally well conducted piece of
research, but given the limitations with the reliability and generalisability of the included
studies, the authors' conclusions should be interpreted with caution
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Health Inequalities Bulletin 21 - August 2010

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Health Inequalities Bulletin 21 - August 2010

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Health Inequalities Bulletin

 Feedback is welcomed to inform future issues of the bulletin.

Bulletin produced by NHS Outreach Librarians

Black and Ethnic Minorities

Ethnic inequalities in access to and outcomes of healthcare: Analysis of the Health

Tackling Race Inequality: Summary of responses

Use of mental health services by minority ethnic groups in England

Ethnicity and alcohol: a review of the UK literature

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Children and Young People

Bulletin produced by NHS Outreach Librarians

Anti-social Behaviour Family Intervention Projects: Monitoring and evaluation

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Communities and Neighbourhoods

Bulletin produced by NHS Outreach Librarians

Work and worklessness in deprived neighbourhoods

Evaluation of the National Strategy for Neighbourhood Renewal: Final report

Financial Management After the Downturn

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Bulletin produced by NHS Outreach Librarians

Drugs and Alcohol

A systematic review of the clinical and cost-effectiveness of psychological therapy

Tackling problem drug use

Drugs research: an overview of evidence and questions for policy

Sustaining a Healthy Future: Taking Action on Climate Change

Bulletin produced by NHS Outreach Librarians

Future Health: Sustainable places for health and well-being

Health and Climate Change

Street cleanliness in deprived and better-off neighbourhoods

Sharing resources to tackle climate change

Experiencing Landscapes: Capturing the cultural services and experiential qualities of

An analysis of urban transport

Bulletin produced by NHS Outreach Librarians

Local low-carbon economies

The green information gap: mapping the nation's green spaces

Green spaces for health – quality as well as the quantity

Climate change or sustainable development?

Bulletin produced by NHS Outreach Librarians

A successful approach to climate change

A clean bill of health: how councils’ environmental protection work

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Housing & Neighbourhoods Monitor: Analysis of housing and neighbourhoods trends

Bulletin produced by NHS Outreach Librarians

Building Better Lives

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Health inequalities in ex-coalfield and industrial communities

Inclusion Health: improving primary care for socially excluded people

Bulletin produced by NHS Outreach Librarians

Health Inequalities (HINST) Enhanced Support Programme resource manual

Health Inequalities Intervention Toolkit

Healthy balance: a review of public health performance and spending

Monitoring poverty and social exclusion 2009

Bulletin produced by NHS Outreach Librarians

Improving partnership working to reduce health inequalities

The social determinants of health and the role of local government

Healthy Communities Direction of Travel Survey results 2009

Fair Society, Healthy Lives (Marmot Review)

Taking forward the role of council regulators

Doctors role in reducing inequalities

Bulletin produced by NHS Outreach Librarians

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Obesity Annual Evidence Update