Phil Hanlon

The health and socioeconomic impacts of major multi-sport events: systematic review (1978-2008)

Objective To assess the effects of major multi-sport events on health and socioeconomic determinants of health in the population of the city hosting the event. Design Systematic review. Data sources We searched the following sources without language restrictions for papers published between 1978 and 2008: Applied Social Science Index and Abstracts (ASSIA), British Humanities Index (BHI), Cochrane database of systematic reviews, Econlit database, Embase, Education Resources Information Center (ERIC) database, Health Management Information Consortium (HMIC) database, International Bibliography of the Social Sciences (IBSS), Medline, PreMedline, PsycINFO, Sociological Abstracts, Sportdiscus, Web of Knowledge, Worldwide Political Science Abstracts, and the grey literature. Review methods Studies of any design that assessed the health and socioeconomic impacts of major multi-sport events on the host population were included. We excluded studies that used exclusively estimated data rather than actual data, that investigated host population support for an event or media portrayals of host cities, or that described new physical infrastructure. Studies were selected and critically appraised by two independent reviewers. Results Fifty four studies were included. Study quality was poor, with 69% of studies using a repeat cross-sectional design and 85% of quantitative studies assessed as being below 2+ on the Health Development Agency appraisal scale, often because of a lack of comparison group. Five studies, each with a high risk of bias, reported health related outcomes, which were suicide, paediatric health service demand, presentations for asthma in children (two studies), and problems related to illicit drug use. Overall, the data did not indicate clear negative or positive health impacts of major multi-sport events on host populations. The most frequently reported outcomes were economic outcomes (18 studies). The outcomes used were similar enough to allow us to perform a narrative synthesis, but the overall impact of major multi-sport events on economic growth and employment was unclear. Two thirds of the economic studies reported increased economic growth or employment immediately after the event, but all these studies used some estimated data in their models, failed to account for opportunity costs, or examined only short term effects. Outcomes for transport were also similar enough to allow synthesis of six of the eight studies, which showed that event related interventions—including restricted car use and public transport promotion—were associated with significant short term reductions in traffic volume, congestion, or pollution in four out of five cities. Conclusions The available evidence is not sufficient to confirm or refute expectations about the health or socioeconomic benefits for the host population of previous major multi-sport events. Future events such as the 2012 Olympic Games and Paralympic Games, or the 2014 Commonwealth Games, cannot be expected to automatically provide benefits. Until decision makers include robust, long term evaluations as part of their design and implementation of events, it is unclear how the costs of major multi-sport events can be justified in terms of benefits to the host population.

The aftershock of deindustrialization—trends in mortality in Scotland and other parts of post-industrial Europe

BACKGROUND Post-industrial decline is frequently cited as one of the major underlying reasons behind the poor health profile of Scotland and, especially, West Central Scotland (WCS). This begs the question: to what extent is poor health a common outcome in other post-industrial regions and how does Scotlands experience compare to these other comparable regions? METHODS Regions were identified by means of an expert-based consultation, backed up by analysis of regional industrial employment loss over the past 30 years. Mortality rates and related statistics were calculated from data obtained from national and regional statistical agencies. RESULTS Twenty candidate regions (in: Belgium; France; Germany; Netherlands; UK; Poland; Czech Republic) were identified, of which ten were selected for in-depth analyses. WCS mortality rates are generally higher and-crucially-appear to be improving at a slower rate than in the other post-industrial regions. This relatively poor rate of improvement is largely driven by mortality among the younger working age (especially male) and middle-aged female populations. CONCLUSION WCS mortality trends compare badly with other, similar, post-industrial regions of Europe, including regions in Eastern Europe which tend to be characterized by higher levels of poverty. This finding challenges any simplistic explanation of WCSs poor health being caused by post-industrial decline alone, and begs the question as to what other factors may be at work.

Peak oil: will it be public health's greatest challenge?

The health of populations is determined more by the social and economic determinants of health than by changes in technology, health services or short-term policy interventions. In the near future, there is likely to be a significant shortfall in energy supply, resulting in high energy prices and a reversal of many of the aspects of globalization that are currently taken for granted. If this happens, economic recession and restructuring could have a negative impact on health, not dissimilar to that experienced by the former Soviet Union when it attempted a rapid change in its economy. There is, however, the potential, through economic planning and sustainable development, to reduce the adverse effects of this change and use this opportunity to impact on a range of diseases which are, at least in part, caused by overconsumption, inequality and loss of community.

Health checks and coronary risk: further evidence from a randomised controlled trial.

Abstract Objectives:To determine the effectiveness of a health check and assess any particular benefits resulting from feedback of plasma cholesterol concentration or coronary risk score, or both Design:Randomised controlled trial in two Glasgow work sites Subjects:1632 employees (89% male) aged 20 to 65 years. Interventions: At the larger work site, (a) health education; (b) health education and feedback on cholesterol concentration; (c) health education and feedback on risk score; (d) health education with feedback on cholesterol concentration and risk score (full health check); (e) no health intervention (internal control). At the other work site there was no health intervention (external control). Main outcome measuresChanges in Dundee risk score, plasma cholesterol concentration, diastolic blood pressure, body mass index, and self reported behaviours (smoking, exercise, alcohol intake, and diet) in comparison with internal and external control groups Results:Comparisons between the full health check and the internal control groups showed a small difference (0.13 mmol/l) in the change in mean cholesterol concentration (95% confidence interval 0.02 to 0.22, P=0.02) but no significant differences for changes in Dundee risk score (P=0.21), diastolic blood pressure (P=0.71), body mass index (P=0.16), smoking (P=1.00), or exercise (P=0.41). Significant differences between the two groups were detected for changes in self reported consumption of alcohol (41% in group with full health check v 17% in internal control group, P=0.001), fruit and vegetables (24% v 12%, P<0.001), and fat (30% v 9%, P<0.001). Comparison of all groups showed no advantage from feedback of cholesterol concentration or risk score, or both. Conclusions:The health check only had a small effect on reversible coronary risk. It was effective in influencing self reported alcohol consumption and diet. Feedback on cholesterol concentration and on risk score did not provide additional motivation for a change in behaviour.

Mental health as a reason for claiming incapacity benefit - a comparison of national and local trends.

BACKGROUND Getting incapacity benefit (IB) claimants into work has become a focus for policy makers. Strategies to help this group depend on an understanding of the reasons for claiming benefit at a local level where variations from a national strategy may be needed. METHODS Data supplied by the Department for Work and Pensions (DWP) was analysed to establish reasons for claiming benefit in Scotland and Glasgow between 2000 and 2007. RESULTS There has been a continuing rise in mental health diagnosis and a corresponding fall in musculoskeletal diagnosis during this period. More people were claiming because of mental health problems in Glasgow than in Scotland. Also those with a poor employment history (credits-only claimants) are more likely to claim IB because of a mental health problem. This study has shown a breakdown into 25 categories those claiming IB because of a mental health problem. CONCLUSION DWP data can be used to provide important insights into the trends in reasons for claiming IB, in particular those claiming because of mental health problems. This study also highlighted the growing importance of problems caused by alcohol and drug-abuse claimants, a subset of the mental health category. DWP data should be used at a local as well as a national level to guide and evaluate interventions to help this vulnerable group.

Do we face a third revolution in human history? If so, how will public health respond?

Background A range of evidence suggests that the dominant culture associated with the economic systems of ‘modern’ societies has become a major source of pressure on global resources and may precipitate a third revolution in human history, with major implications for health and well-being. Objective This paper aims to consider whether there are historical analogies with contemporary circumstances which might help us make connections between past and present predicaments in the human condition; to highlight the underpinnings of such predicaments in the politico-economic and cultural systems found in ‘modern’ societies; to outline questions prompted by this analysis, and stimulate greater debate around the issues raised. Methods We draw on evidence and arguments condensed from complex research and theorizing from multiple disciplines. Results Contemporary evidence suggests that global depletion of a key energy resource (oil), increasing environmental degradation and imminent climate change can be linked to human socio-economic and cultural systems which are now out of balance with their environment. Those systems are associated with Western-type societies, where political philosophies of neo-liberalism, together with cultural values of individualism, materialism and consumerism, support an increasingly globalized capitalist economic system. Evidence points to a decline of psychological and social well-being in such societies. Conclusion We need to work out how to prevent/ameliorate the harms likely to flow from climate change and rising oil costs. Public health professionals face the challenge of preventing adverse health consequences likely to result from continued adherence to the have-it-all mindset prevailing in contemporary Western societies. Equally, we need to seek out the potential health dividends that could be realized in terms of reduced obesity, improved well-being and greater social equity, while not under-estimating the likelihood of profound resistance, from many sectors of society, to unwanted but inevitable change.

The complex territory of well‐being: contestable evidence, contentious theories and speculative conclusions

This paper brings together evidence and theories from a number of disciplines and thinkers that highlight multiple, sometimes incommensurable understandings about well‐being. We identify three broad strands or themes within the literature(s) that frame both the nature of the problem and its potential solutions in different ways. The first strand can be categorised as the ‘hard’ science of wellbeing and its stagnation or decline in modern western society. In a second strand, social and political theory suggests that conceptualisations of well‐being are shaped by aspects of western culture, often in line with the demands of a capitalist economic system. A third theme pursues the critique of consumer cultures influence on well‐being but in the context of broader human problems. This approach draws on ecology, ethics, philosophy and much else to suggest that we urgently need to reconsider what it means to be human, if we are to survive and thrive. Although no uncontroversial solutions are found within any of these themes, all play a necessary part in contributing to knowledge of this complex territory, where assumptions about the nature of the human condition come into question.

Climate change and rising energy costs will change everything: a new mindset and action plan for 21st century public health.

Western governments currently prioritize economic growth and the pursuit of profit above alternative goals of sustainability, health and equality. Climate change and rising energy costs are challenging this consensus. The realization of the transformation required to meet these challenges has provoked denial and conflict, but could lead to a more positive response which leads to a health dividend; enhanced well-being, less overconsumption and greater equality. This paper argues that public health can make its best contribution by adopting a new mindset, discourse, methodology and set of tasks.

How will area regeneration impact on health? Learning from the GoWell study

OBJECTIVES To establish the theoretical and perceived links between area regeneration and health in a Scottish context in order to inform a comprehensive evaluation of regeneration activity. The evaluation will include health outcomes. STUDY DESIGN Mixed method combining and comparing key informant interviews with policy analysis. METHODS Analysis of identified links between elements of regeneration activity and health was undertaken of published policies and strategies which described regeneration for Scotland and the city of Glasgow. Interviews with key informants explored their understanding of the inputs to regeneration, and the pathways between regeneration and better health outcomes. RESULTS The policy analysis and interviews revealed a holistic approach to a complex problem. Both identified a need for action to improve housing, neighbourhoods and services, education, employment, community participation and social issues. Improved health was identified as an emergent property. Interviewees identified a need to augment the established structural components with a more person-centred approach, fostering confidence and higher aspirations, but were uncertain how to achieve this. The interviews revealed a lack of confidence that current practice would deliver all the components of the holistic model. CONCLUSIONS A holistic model of regeneration appears to inform policy, but is proving difficult to deliver. Improved health and reduced health inequalities were not primary objectives but emergent properties. In light of this, the ability of regeneration to actively maximize positive health impacts, particularly if this requires focused planning or opportunity costs to other activities, is questioned.

‘Well-being’ as a focus for public health? A critique and defence

The concept of well-being has long attracted attention from multiple academic disciplines and interest has now spilled over into public and political domains in the UK. Yet a number of critical arguments might be made in relation to its utility for public health. For example, subjective well-being is broad and ill-defined, and is associated with contestable, morally laden ideas about happiness and ‘the good life’. Well-being has highly individualistic connotations and buys uncritically into the consumer culture of Western economies. The focus on well-being reinforces personal responsibility whilst intensifying the penetration of the individuals lifeworld by a range of experts or therapies. As a concern of the worried well of wealthy nations, well-being could exacerbate existing inequalities. Well-being may thus present a distraction from efforts to address enduring structural inequalities in health. Nevertheless, arguments can be made in its defence, not least the burgeoning science on the topic, and the suggestion that well-being may be an appropriate measure of what people value in life, and therefore relevant to public health. In this paper, we present a synthesis of favourable and critical perspectives on the topic. This provides the foundation for a critique of the diagnoses and prescriptions found in both positions. More broadly, we highlight doubts about the sustainability of the current, modernist paradigm which has failed to substantially reduce health or other inequalities yet to which contemporary public health efforts apparently remain tied. We suggest that a re-think in public health policy and practice may be required.