Alan Maryon-Davis

Reducing health inequalities in priority public health conditions: using rapid review to develop proposals for evidence-based policy

BACKGROUND In November 2008, the Secretary of State for Health (England) commissioned an independent review to propose effective strategies for reducing health inequalities. Review task groups were given just 3 months to make preliminary evidence-based recommendations. In this paper, we describe the methodology used, and the recommendations made, by the group tasked with inequalities in priority public health conditions. METHODS A series of rapid literature reviews of the policy-relevant international evidence base was undertaken. Quantitative studies of any design, which looked at the effects on health inequalities, the social gradient or overall population health effects, of interventions designed to address the social determinants of selected public health priority conditions were examined. Recommendations were distilled using a Delphi approach. RESULTS Five key policy proposals were made: reduce smoking in the most deprived groups; improve availability of and access to healthier food choices amongst low income groups; improve the early detection and treatment of diseases; introduce a minimum price per unit for alcohol and improve the links between physical and mental health care. CONCLUSION The combination of rapid review and Delphi distillation produced a shortlist of evidence-based recommendations within the allocated time frame. There was a dearth of robust evidence on the effectiveness and cost-effectiveness of the interventions we examined: our proposals had to be based on extrapolation from general population health effects. Extensive, specific and robust evidence is urgently needed to guide policy and programmes. In the meantime, our methodology provides a reasonably sound and pragmatic basis for evidence-based policy-making.

Using the Mass Media to Promote Health

The mass media, by communicating with people in large numbers, can have a huge impact on the publics knowledge, beliefs, perceptions, attitudes and behaviours, not only as individuals but also as families, communities and wider society. The power and reach of the mass media can influence all aspects of peoples lives, including health and well-being, and can be harnessed to promote health by informing, motivating and empowering people to change behaviour and by providing a platform for advocating healthier policies and civic action. This article considers some of the basic principles and approaches of using the mass media to promote health. It looks at the changing media landscape including the advent of social networking tools and signposts readers to practical advice on how to get involved and develop their skills.

Legislating for health-related gain: striking a balance

See related research article by Naiman and colleagues, page [761][1] When is it right to use the big stick of legislation to change people’s unhealthy habits? How can governments avoid being accused of interfering too much in our private lives? What is the optimal balance between laissez-faire-

Data access is matter of trust

The UK Faculty of Public Health strongly supports the BMJ ’s call for mandatory disclosure of raw data of all trials cited in drug licensing applications and …

Achieving health equity for all

The Commission on Social Determinants of Health sets out its vision and goals

The rocky road to solar power: fiction and fact

‘An energy source drenches our planet, drives its climate and its life. It falls on us in a constant stream, a sweet rain of photons. . . . A fraction of our hot deserts could power our civilization. No one can own sunlight, no one can privatize or nationalize it. Soon, everyone will harvest it . . . some of the poorest countries in the world are the solar rich. We could help them by buying their megawatts. And domestic consumers will love making power out of sunlight and selling it to the grid. It is primal’. These are the prophetic words of Professor Michael Beard, physicist, Nobel Laureate, popularizer of science, trailblazer for solar energy on a massive scale . . . and fictional antihero in Ian McEwan’s latest novel Solar. Beard is addressing an audience of assorted business people, investment bankers, pension–fund managers, captains of industry and assorted hangers-on at a conference in London’s famous Savoy Hotel. It is stirring stuff in a language they understand. ‘The market will be even more lucrative than coal or oil . . . Colossal fortunes will be made. The sector is seething with vitality, invention—and above all, growth’. His words are striking home, rapt attention, nods of assent. Big Business is taking it all in. Beard is gratified. His talk has gone down well. But this is not his main preoccupation. His overriding concern as he reaches his final flourish is a mounting feeling of intense nausea. It must be the handfuls of stale smoked salmon sandwiches he stuffed himself with just before taking the podium. He cannot hold it back any longer. With the applause ringing in his ears, he darts between the curtains behind him and throws up a slew of fishy slurry among the stacked chairs. Michael Beard is all too human. Brilliant but fallible. Conceited but vulnerable. Passionate but careless and unthinking. Selfish, greedy, sensuous, clumsy, bully, coward and callous charmer. He is going through the last throes of his fifth marriage. Lovable but impossible. A winner and a loser. He achieved early greatness through his inspired exposition of a unifying theoretical construct that became known as the Beard-Einstein Conflation. But in the years since then had found himself coasting along, resting on his laurels, not having any new ideas, no real spark and rather half-heartedly running a government-funded renewable energy institute just outside reading in the Thames Valley. He had peaked too early and, although still listened to and respected, was essentially treading water and going nowhere. Until a freak accident involving his wife’s lover gave him, unexpectedly and undeservedly, a whole new lease of life—and the opportunity to re-invent himself as the pioneer of a groundbreaking new solar energy technology that could not only save the world, but also his flagging reputation. What follows in this very engaging novel is a romping cocktail of dark motives, hilarious serendipities and quirky but utterly believable characters all bouncing off Beard’s zig-zag progress towards what turns out to be his own personal climactic conflation. On the way are some great moments—many of which involve embarrassing mishaps and excruciating misunderstandings. It is a very good read—and to my mind his most enjoyable and all-round satisfying book so far. It is also wonderfully well observed, expertly informed and absolutely up-to-the-minute. Certainly, it is the first novel I have come across involving an odious serial womanizer who eats too much, gets into awful scrapes, exploits another person’s ideas and becomes an international innovator in photovoltaic technology. McEwan finished writing Solar ahead of the 2009 climate change summit in Copenhagen and before the latest dash to photovoltaics began in earnest. Now suddenly all the big players are piling in and jockeying for position. China and India are hugely excited about it, hosting major international

Concerns about tobacco control

In discussing whether the UK is turning the clock back on public health advances,1 the fact that the coalition government is considering mandatory plain brown packets for cigarettes is encouraging.2 However, this move, which may get held up in the courts, must not delay implementing …

Public health exposes jargon epidemic

Dobson’s news article highlighting a recent analysis of the management-speak content of the Faculty of Public Health’s annual conference helps to surface a major elephant in the room, which calls for “hands-on engagement” …