Alison Copeland

The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England

Objectives To: (1) determine the percentage of the population in England that have access to a community pharmacy within 20 min walk; (2) explore any relationship between the walking distance and urbanity; (3) explore any relationship between the walking distance and social deprivation; and (4) explore any interactions between urbanity, social deprivation and community pharmacy access. Design This area level analysis spatial study used postcodes for all community pharmacies in England. Each postcode was assigned to a population lookup table and lower super output area (LSOA). The LSOA was then matched to urbanity (urban, town and fringe or village, hamlet and isolated dwellings) and deprivation decile (using the Index of Multiple Deprivation score). Primary outcome measure Access to a community pharmacy within 20 min walk. Results Overall, 89.2% of the population is estimated to have access to a community pharmacy within 20 min walk. For urban areas, that is 98.3% of the population, for town and fringe, 79.9% of the population, while for rural areas, 18.9% of the population. For areas of lowest deprivation (deprivation decile 1) 90.2% of the population have access to a community pharmacy within 20 min walk, compared to 99.8% in areas of highest deprivation (deprivation decile 10), a percentage difference of 9.6% (8.2, 10.9). Conclusions Our study shows that the majority of the population can access a community pharmacy within 20 min walk and crucially, access is greater in areas of highest deprivation—a positive pharmacy care law. More research is needed to explore the perceptions and experiences of people—from various levels of deprivation—around the accessibility of community pharmacy services.

Access all areas? An area-level analysis of accessibility to general practice and community pharmacy services in England by urbanity and social deprivation

Objectives (1) To determine the percentage of the population in England that has access to a general practitioner (GP) premises within a 20 min walk (the accessibility); (2) explore the relationship between the walking distance to a GP premises and urbanity and social deprivation and (3) compare accessibility of a GP premises to that of a community pharmacy—and how this may vary by urbanity and social deprivation. Design This area-level analysis spatial study used postcodes for all GP premises and community pharmacies in England. Each postcode was assigned to a population lookup table and Lower Super Output Area (LSOA). The LSOA was then matched to urbanity (urban, town and fringe, or village, hamlet and isolated dwellings) and deprivation decile (using the Index of Multiple Deprivation score 2010). Primary outcome measure Living within a 20 min walk of a GP premises. Results Overall, 84.8% of the population is estimated to live within a 20 min walk of a GP premises: 81.2% in the most affluent areas, 98.2% in the most deprived areas, 94.2% in urban and 19.4% in rural areas. This is consistently lower when compared with the population living within a 20 min walk of a community pharmacy. Conclusions Our study shows that the vast majority of the population live within a 20 min walk of a GP premises, with higher proportions in the most deprived areas—a positive primary care law. However, more people live within a 20 min walk of a community pharmacy compared with a GP premises, and this potentially has implications for the commissioning of future services from these healthcare providers in England.

Healthy land? an examination of the area-level association between brownfield land and morbidity and mortality in England

It is increasingly understood that the physical environment remains an important determinant of area-level health and spatial and socioeconomic health inequalities. Existing research has largely focused on the health effects of differential access to green space, the proximity of waste facilities, or air pollution. The role of brownfield—or previously developed—land has been largely overlooked. This is the case even in studies that utilise multiple measures of environmental deprivation. This paper presents the results of the first national-scale empirical examination of the association between brownfield land and morbidity and mortality, using data from England. Census Area Statistical ward-level data on the relative proportion of brownfield land (calculated from the 2009 National Land Use Database), standardised morbidity (2001 Census measures of ‘not good’ general health and limiting long-term illness), and premature (aged under 75 years) all-cause mortality ratios from 1998/99 to 2002/03 were examined using linear mixed modelling (adjusting for potential environmental, socioeconomic, and demographic confounders). A significant and strong, adjusted, area-level association was found between brownfield land and morbidity: people living in wards with a high proportion of brownfield land are significantly more likely to suffer from poorer health than those living in wards with a small proportion of brownfield land. This suggests that brownfield land could potentially be an important and previously overlooked independent environmental determinant of population health in England. The remediation and redevelopment of brownfield land should therefore be considered as a public health policy issue. Keywords: regeneration, environment, deprivation, neighbourhood

All in It Together? The Effects of Recession on Population Health and Health Inequalities in England and Sweden, 1991–2010

This article is the first to comparatively examine the effects of two recessions on population health and health inequalities in the two historically contrasting welfare states of England and Sweden. Data from 1991–2010 on self-reported general health, age, gender, and educational status were obtained from the Health Survey for England, the Swedish Survey of Living Conditions, and the European Union Survey of Income and Living Conditions, for individuals aged over 16. Generalized linear models were used to test the effects of recessions on self-reported health and educational inequalities in health. Overall, recessions had a significant positive effect on the health of women—but not men—in both England (4%) and Sweden (7%). In England, this improvement was only enjoyed by the most educated women, with the health of less educated women declining during recession. In contrast, in Sweden, the health of all women improved significantly during recession regardless of their educational status, although the most educated benefitted the most. Relative educational inequalities in self-reported health therefore increased during recessions in both countries by 14 percent (England) and 17 percent (Sweden) but for different reasons. This study suggests that Swedens welfare state protects the health of all during recessions.

Improving health and lives : the learning disabilities public health observatory

Purpose – The purpose of this paper is to describe the first 15 months of operation of an innovative specialist national public health observatory for intellectual disability. Design/methodology/approach – The paper provides a narrative account of aims and achievements of the service. Findings – In the first 15 months of operation the observatory has: made available to those involved in commissioning health and social care services, a wealth of information on the health needs of people with intellectual disabilities; identified specific improvements that could viably be made to increase the quality of future information; and begun working with local agencies to support them in making the best use of the available information. Originality/value – People with intellectual disabilities experience significant health inequalities. This paper describes an innovative approach to helping local agencies make the best use of available information in order to commission services that may reduce these inequalities.

Deprived areas will lose out with proposed new capitation formula.

NHS funding is allocated to areas on the principle of providing “equal opportunity of access for equal need.”1 To help achieve this, the current NHS allocation formula incorporates a deprivation related measure: the “health inequality weighting.”1 The relative roles of deprivation and age as determinants of health have been subject to political debate over the past years,2 3 4 and NHS England is consulting …

This divided land: An examination of regional inequalities in exposure to brownfield land and the association with morbidity and mortality in England.

This paper is the first empirical examination of the association between brownfield land and spatial inequalities in health. Linear mixed modelling of ward-level data suggests that there is higher exposure and susceptibility to brownfield land in the Northern compared to the Southern regions (with the exception of London); that brownfield exposure has an association with regional inequalities in mortality and morbidity within regions (particularly in the North West); that brownfield has an association with inequalities between regions (particularly between the North West and the South East); but that brownfield land only makes a small independent contribution to the North-South health divide in England. However, brownfield land could be a potentially important and previously overlooked independent environmental determinant of spatial inequalities in health in England.

A prototype index of factors affecting mental wellbeing in England

Purpose – This paper seeks to discuss the development of a prototype index of the factors influencing mental wellbeing in local areas in England.Design/methodology/approach – To support developments in mental health policy, a prototype version of an index of the extent of factors affecting wellbeing was developed for the 149 local government areas (local authorities). The work was based on a well‐developed conceptualisation of factors affecting mental wellbeing set out in a current Department of Health background paper. This identified five domains of relevant factors with positive and negative influences in each. For each of the five domains (“a positive start in life”, “resilience and a safe and secure base”, “integrated physical and mental health” “sustainable, connected communities”, and “meaning and purpose”), the authors attempted to find proxy measures of positive and risk factors among routinely collected government statistics. This proved difficult; measures for positive factors in three domains ...