Patrick Saunders

The determinants of health-seeking behaviour during the A/H1N1 influenza pandemic: an ecological study

Abstract Background This is an ecological study that examines the relationship between antiviral drug collection during the 2009/2010 A/H1N1 influenza pandemic, and area-level ethnicity, socioeconomic deprivation and distance from an antiviral collection point (ACP). Methods Age-standardized antiviral collection rates (ACR) were calculated for each super output area (geographic areas representing a population of ∼1500) in Sandwell, UK for all residents who received an antiviral drug for influenza-like illness between 23 July 2009 and 7 February 2010. Multivariable regression was used to examine the relationship between ACR and ethnicity (percentage population non-white), socioeconomic deprivation (index of multiple deprivation, IMD) and distance from an ACP. Results Socioeconomic deprivation, ethnicity and distance from an ACP were independently associated with a reduction in ACR. Each one-point increase in the IMD score was associated with a drop in the ACR of 15.7 prescriptions per 100 000 population (P= 0.013). Conclusions Socioeconomic deprivation, ethnicity and distance from an ACP may have influenced health-seeking behaviour during the 2009/2010 influenza pandemic. This suggests possible inequalities in access to antivirals during the most recent influenza pandemic. Qualitative research is needed to examine the reasons for this. Individual-level data on ethnicity should be routinely collected in the event of a future pandemic.

A review of the public health impacts of unconventional natural gas development

The public health impact of hydraulic fracturing remains a high profile and controversial issue. While there has been a recent surge of published papers, it remains an under-researched area despite being possibly the most substantive change in energy production since the advent of the fossil fuel economy. We review the evidence of effects in five public health domains with a particular focus on the UK: exposure, health, socio-economic, climate change and seismicity. While the latter would seem not to be of significance for the UK, we conclude that serious gaps in our understanding of the other potential impacts persist together with some concerning signals in the literature and legitimate uncertainties derived from first principles. There is a fundamental requirement for high-quality epidemiological research incorporating real exposure measures, improved understanding of methane leakage throughout the process, and a rigorous analysis of the UK social and economic impacts. In the absence of such intelligence, we consider it prudent to incentivise further research and delay any proposed developments in the UK. Recognising the political realities of the planning and permitting process, we make a series of recommendations to protect public health in the event of hydraulic fracturing being approved in the UK.

Wider horizons, wiser choices: horizon scanning for public health protection and improvement

Background Systematic continuous thinking about the future helps organizations, professions and communities to both prepare for, and shape, the future. This becomes ever more critical given the accelerating rate at which new data emerge, and in some cases uncertainties around their reliability and interpretation. Businesses with the capability to filter and analyse vast volumes of data to create knowledge and insights requiring action have a competitive advantage. Similarly Government and the public sector, including public health can be more effective and efficient through the early identification of emerging issues (both threats and opportunities). Methods Horizon scanning approaches, and the use of resulting intelligence related to health protection and improvement were reviewed. Results Public health horizon scanning systems have to date focussed on health technologies and infectious diseases. While these have been successful there is a major gap in terms of non-infectious hazards and health improvement. Conclusion Any system to meet this need must recognize the changed environment for delivering front line public health services and the critical role of local authorities and the local democratic process. This presents opportunities and challenges and this paper explores those dynamics describing an existing environment and health horizon scanning system which could readily and rapidly be re-engineered to provide a national service.

Current evidence shows no place for antiviral drug distribution in a flu pandemic

The BMJ and Cochrane Collaboration showed serious generic failings in the system of publishing full trial evidence about oseltamivir for flu.1 We remain concerned, however, that the insights of service providers during the 2009-10 pandemic have not been given the same public consideration.2 Even the selective evidence available in 2009 cannot justify the financial and public health …

Global warming must stay below 1.5°C

We are facing a global emergency and should organise accordingly

Fracking and health

The scale of harm to health is uncertain, but the danger of exacerbating climate change is not

Survey of directors of public health suggests that STPs may be falling short of ambition

The Faculty of Public Health supports sustainability and transformation plans (STPs) and their reflection of a renewed commitment to “integration, collaboration, and planning” and “improving prevention” critical to delivering the Five Year Forward Plan.1 The faculty anticipated that the 2013 reintegration of the NHS public health function with local authorities was an opportunity for powerful public health input. It surveyed directors of public health …