Roy Carr-Hill

Shopping for Food: lessons from a London borough

Purpose – This paper aims to measure access to food in an inner London borough. Design/methodology/approach – There were six phases, which included designing food baskets, consultation with local residents and a shop survey. Recognising the cultural make-up of the borough food baskets and menus were developed for four key communities, namely: White British, Black Caribbean, Turkish, and Black African. Three areas were identified for the study and shopping hubs identified with a 500-metre radius from a central parade of shops. Findings – The findings paint an intricate web of interactions ranging from availability in shops to accessibility and affordability being key issues for some groups. It was found that in the areas studied there was availability of some key healthy items, namely fresh fruit and vegetables, but other items such as: fresh meat and poultry, fish, lower fat dairy foods, high fibre pasta and brown rice were not available. Access was found to be defined, by local people, as more extensive than just physical distance to/from shops – for many shopping was made more difficult by having to use taxis and inconvenient buses. Small shops were important in delivering healthy food options to communities in areas of deprivation and were judged to offer a better range and more appropriate food than the branches of the major supermarket chains. Research limitations/implications – The importance of monitoring the impact of shops and shop closures on healthy food availability is emphasised. From a policy perspective the findings suggest that approaches based on individual agency need to be balanced with upstream public health nutrition approaches in order to influence the options available. Originality/value – The paper is arguably the first to examine and dissect the issue of food availability and accessibility in the inner London borough in question, especially in the light of its proposed redevelopment for the London Olympics in 2012.

Are health‐promoting prisons an impossibility? Lessons from England and Wales

Investigates 1999/2000 health promotion activities in prisons in England and Wales and documents the range and quality of health promotion occurring in prisons, against which future activity might be measured. Finds that health promotion is under‐resourced and the concept and practice poorly understood. Health needs assessment tended to be analysis of and for health‐care services and, except in a minority of cases, did not include consultation with staff, prisoners or their families. Where responsibility was shared and the work based on multi‐disciplinary approaches, it seems more likely to have been reported accurately as health promotion activity. The official policy of a healthy settings/whole prison approach was not understood by many and its application was limited. The findings have informed the development of a new health promotion strategy for the prison service in England and Wales.

Risk adjustment for hospital use using social security data: cross sectional small area analysis.

Abstract Objectives: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. Design: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. Setting: Northern Ireland. Main outcome measure: Intensity of use of inpatient services. Results: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. Conclusions: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula. What is already known on this topic Use of hospital services at small area level is related to supply and census derived proxy measures of socioeconomic status as well as morbidity Changes to census data can be determined only every 10 years What this study adds Social security data directly reflecting household income predicts use of inpatient services Use of social security data allowed development of a risk adjustment model in which four of the five variables can be updated annually The main effect of the resulting formula is to move resources from urban to rural areas

Challenges and opportunities associated with the introduction of assistant practitioners supporting the work of registered nurses in NHS acute hospital trusts in England

Objectives To understand the challenges and opportunities associated with the introduction of assistant practitioner (AP) roles supporting the work of ward-based registered nurses (RNs) in National Health Service (NHS) acute hospital trusts in England. Methods Three case studies of NHS acute hospital trusts. This paper presents qualitative findings, drawing on documentary data sources and data generated through interviews and focus group discussions. Results Introduction of APs into ward-based nursing teams has been variable, and often driven by external pressures rather than perceived organizational need. This, along with little national guidance, has created some confusion about the role, but at the same time has permitted flexible role development through ‘negotiated compromise’ at local level. While there are various areas of potential improvement in policy and practice, APs are generally perceived to have the potential to make a valuable contribution to patient care. Conclusions Findings from this study will help policy-makers, organizations and practitioners understand factors that enable and/or inhibit the integration of new assistant roles within existing occupational structures to develop innovative services and enhance patient care. These factors are important when considering how care will be delivered to maximize the skills of the entire nursing workforce.

Tackling the drivers of child undernutrition in developing countries: what works and how should interventions be designed?

OBJECTIVE The present paper presents a synthesis of available evidence to support action on the interventions that can effectively address the main drivers of child undernutrition in developing countries. It also discusses how interventions should be designed and identifies policy-relevant areas for further research. DESIGN A structured literature review of fifty-eight controlled evaluations and studies in developing countries were selected because they are methodologically sound, recent (reported within the past 10 years), report on nutritional status, cover a wide range of interventions and are implemented by a range of different agencies. SETTING Indirect interventions in developing countries, which address the underlying and basic causes of child undernutrition and can potentially be implemented in the short to medium term. SUBJECTS Children under 5 years of age and their mothers across a range of developing countries. RESULTS Evidence has now accumulated to guide action on a range of indirect interventions that can reduce child undernutrition, but for all these interventions context is all-important. There is less evidence on how these interventions can be effectively implemented on a large scale. CONCLUSIONS Efforts should be directed towards improving implementation of effective interventions on a large scale. Donors need to keep commitments both in dollar terms and in terms of the Paris Declaration so that the push for improved nutrition does not become donor driven. At the country level, there is a need for enabling governance structures, institutions and evidence-based decision making. Within countries there is a need for well-trained personnel with delegated authority, accountable to local people. It is essential for chains of accountability to be transparent and for active involvement of households in decision-making processes.

Establishing the economics of engaging communities in health promotion: what is desirable, what is feasible?

Over the last 30 years, there has been a growing recognition of the potential for community-based efforts to improve public health. However, the costs and ‘added value’ of community engagement approaches remain unclear. This paper reports findings from a systematic review of the economic evidence relating to planning, design, delivery or governance of health promotion interventions. Key databases were searched, review bibliographies were checked and experts in the field of economics of public health were consulted. To be eligible for inclusion, studies needed to report community engagement or community development approaches for primary health promotion; to include a control or suitable comparator group; and to assess both health outcomes and costs. Data were extracted and studies were quality assessed. Of the 4405 references screened, 152 records (3%) were potentially relevant and eight studies met the inclusion criteria for the review. Seven studies reported positive findings, but no study was designed to evaluate the impact or cost-effectiveness of a specifically ‘community-engagement’ component. The review found tentative evidence that community engagement as part of a multifaceted approach to health promotion may have positive effects and could be cost-effective. To improve the evidence base for community engagement, future studies need to involve communities more closely at all stages of the research in order to fully capture the communitys priorities and perspectives, and appropriately assess the value added and opportunity cost of engagement.

The attitudes of primary schoolchildren in Northern Thailand towards their peers who are affected by HIV and AIDS

Abstract After more than a decade of the AIDS epidemic in Thailand, the number of children whose parents are living with HIV or have died from AIDS is increasing significantly and it has been reported that these children are often discriminated against by their peers. In order to better understand the current situation and to explore possible strategies to support HIV-affected children, this study examined childrens attitudes towards HIV and AIDS using questionnaires and focus group discussions with children in Grades three–six in five primary schools in a northern province in Thailand. A total of 513 children (274 boys and 239 girls) answered the questionnaire and five focus groups were organised. The findings showed a strong positive correlation between childrens belief that HIV could be transmitted through casual contact and their negative attitudes towards their HIV-affected peers. Most children overestimated the risk of HIV transmission through casual contact and this made their attitudes less tolerant and less supportive. After HIV prevention education (which included information on HIV transmission routes) was given in three of the study schools, the same questionnaire and focus groups were repeated and the findings showed that childrens attitudes had become more supportive. These findings suggest that HIV prevention education delivered through primary schools in Thailand can be an effective way to help foster a more supportive and inclusive environment and reduce the stigma and discrimination that decrease educational access and attainment for HIV-affected schoolchildren.

Measuring development progress in Africa: the denominator problem

Abstract In developing countries, assessments of progress towards development goals are based increasingly on household surveys. Typically, they omit by design: the homeless; those in institutions; and mobile, nomadic or pastoralist populations. Moreover, in practice household surveys typically underrepresent: those in fragile, disjointed households; slum populations and areas posing security risks. Those six subgroups constitute a large fraction of the “poorest of the poor”. These “missing” poor are estimated to constitute about 11 per cent of the population of sub-Saharan Africa. Their omission from the sampling frames of household surveys leads to substantial biases in the assessment of progress towards the Millennium Development Goals.

The effectiveness of school-based decision making in improving educational outcomes: a systematic review

ABSTRACT The rhetoric around decentralisation suggests school-based management improves education outcomes. Existing reviews on school-based decision-making have tended to focus on proximal outcomes and offer very little information about why school-based decision-making has positive or negative effects in different circumstances. The authors systematically searched for and synthesised evidence from 35 quantitative and qualitative studies evaluating 17 individual interventions on the effectiveness of school-based decision-making on educational outcomes. Devolving decision-making to the level of the school appears to have a somewhat beneficial effect on dropout, repetition and teacher attendance. Effects on test-scores are more robust, being positive in aggregate and for middle-income countries specifically. On the other hand, school-based decision-making reforms appear to be less effective in communities with generally low levels of education, where parents have low status relative to school personnel. The authors conclude that school-based decision-making reforms are less likely to be successful in highly disadvantaged communities.

Organ donation in Wales

The editorials on organ donation in the February issue do not mention the Welsh experience.1,2 As of 1 December 2015, the Human Transplantation (Wales) Act came into full effect, introducing a presumed consent system, in which every person ordinarily living in Wales voluntarily for longer than 12 months, aged 18 or over, and …