Sue Povall

Evaluating the health inequalities impact of area-based initiatives across the socioeconomic spectrum: a controlled intervention study of the New Deal for Communities, 2002–2008

Background Previous evaluations of area-based initiatives have not compared intervention areas with the full range of areas from top to bottom of the social spectrum to evaluate their health inequalities impact. Setting Deprived areas subject to the New Deal for Communities (NDC) intervention, local deprivation-matched comparator areas, and areas drawn from across the socioeconomic spectrum (representing high, medium and low deprivation) in England between 2002 and 2008. Data Secondary analysis of biannual repeat cross-sectional surveys collected for the NDC National Evaluation Team and the Health Survey for England (HSE). Methods Following data harmonisation, baseline and time trends in six health and social determinants of health outcomes were compared. Individual-level data were modelled using regression to adjust for age, sex, ethnic and socioeconomic differences among respondents. Results Compared with respondents in HSE low deprivation areas, those in NDC intervention areas experienced a significantly steeper improvement in education, a trend towards a steeper improvement in self-rated health, and a significantly less steep reduction in smoking between 2002 and 2008. In HSE high deprivation areas, significantly less steep improvements in five out of six outcomes were seen compared with HSE low deprivation areas. Conclusions Although unable to consider prior trends and previous initiatives, our findings provide cautious optimism that well-resourced and constructed area-based initiatives can reduce, or at least prevent the widening of, social inequalities for selected outcomes between the most and least deprived groups of areas.

The Malaria in Pregnancy Library: a bibliometric review

BackgroundThe Malaria in Pregnancy (MiP) Library is a bibliographic database that was created by the MiP Consortium in 2005 and is updated every four months using a standardized search protocol. A bibliometric review was conducted of the contents of the Library to determine dynamics in the type, content and volume of literature on malaria in pregnancy over time.MethodsData on year of publication, type, language, country of first-author affiliation and content (topic) were extracted from entries in the MiP Library and plotted over time.ResultsBy January 2012, the MiP Library contained 5,346 entries, consisting of 3,721 journal articles (69.6%), 697 reports (13.0%), 219 academic theses (4.1%), 92 books or book chapters (1.7%), 487 conference proceedings (9.1%), 68 registered studies (1.3%) and 62 ‘other’ (1.2%). Most of the sources were in English language (87.3%), followed by French (7.5%) and Spanish (1.5%). Over 40% of source material was publicly available online (42.4%) and the remaining with restricted access (35.0%) or otherwise unavailable (22.7%). The number of journal articles related to malaria in pregnancy increased from 41 in the 1960s, to 708 in the 1990s, and 1,895 between 2000 and 2009, and the variety of themes has increased over time. English-language articles were sourced from 737 different journals. The top three journals were the American Journal of Tropical Medicine and Hygiene (184), Malaria Journal (158) and the Transactions of the Royal Society of Tropical Medicine and Hygiene (131).ConclusionThe last decade has seen a dramatic increase in publications related to malaria in pregnancy, and an increasing proportion of these are publically available online. The MiP Library is a useful, scholarly source for literature and systematic reviews related to malaria in pregnancy.

Health trajectories in regeneration areas in England: the impact of the New Deal for Communities intervention

Background A large body of evidence documents the adverse relationship between concentrated deprivation and health. Among the evaluations of regeneration initiatives to tackle these spatial inequalities, few have traced the trajectories of individuals over time and fewer still have employed counterfactual comparison. We investigate the impact of one such initiative in England, the New Deal for Communities (NDC), which ran from 1999 to 2011, on socioeconomic inequalities in health trajectories. Methods Latent Growth Curve modelling of within-person changes in self-rated health, mental health and life satisfaction between 2002 and 2008 of an analytical cohort of residents of 39 disadvantaged areas of England in which the NDC was implemented, compared with residents of comparator, non-intervention areas, focusing on: (1) whether differences over time in outcomes can be detected between NDC and comparator areas and (2) whether interventions may have altered socioeconomic differences in outcomes. Results No evidence was found for an overall improvement in the three outcomes, or for significant differences in changes in health between respondents in NDC versus comparator areas. However, we found a weakly significant gap in life satisfaction and mental health between high and low socioeconomic status individuals in comparator areas which widened over time to a greater extent than in NDC areas. Change over time in the three outcomes was non-linear: individual improvements among NDC residents were largest before 2006. Conclusions There is limited evidence that the NDC moderated the impact of socioeconomic factors on mental health and life satisfaction trajectories. Furthermore, any NDC impact was strongest in the first 6 years of the programmes.

Farewell to the intelligentsia: Political transformation and changing forms of leisure consumption in the former communist countries of eastern Europe

This paper refers to evidence from studies of young adults conducted in eight different ex‐communist countries from 1993 onwards, but it is based primarily on data gathered in Ukraine, Georgia and Armenia in 2002. The evidence is used to chart the disintegration of the intelligentsia strata that were consolidated under communism. Members were highly educated and were unified by an intelligentsia lifestyle that included the consumption of state‐subsidized high culture and typically involved interest and participation in public affairs. The evidence that is presented shows that under post‐communism higher education graduates continue to be distinguished by their consumption of high culture. However, their occupations are more diverse in terms of work and market situations. Many, especially those in the more intellectual occupations, have been impoverished, state subsidies for their lifestyles having been withdrawn or reduced, making their lifestyles more expensive. The better‐off are now even more exposed to and involved in the new consumer cultures. This paper explains how the cessation of the intelligentsia’s reproduction as a lifestyle group, and the spread of commercial leisure, will have contributed to the post‐1989/91 decline in political interest and activity among young people in the former communist countries of eastern Europe.

Exploring health inequalities through the lens of an ethnographic study of healthy eating provision in the early years sector

The social determinants of health are increasingly receiving international attention since the publication of the World Health Organizations Commission on the Social Determinants of Health in 2008. How different determinants affect health is much debated. Contrasting suggestions include, for example, a major link with socio-economic inequalities, lack of social status and psychosocial stress or the extent of the welfare state. Others emphasise the need to understand the socio-cultural contexts of specific situations. Diet-related health is a good example of the relationship between poor health outcomes and deprivation. The aim of this paper is to explore the specific conditions and contexts that might reduce or exacerbate the provision of a healthy diet to children under 5 years in a range of nurseries supported by the Sure Start Local Programmes initiative in Liverpool. An ethnographic approach was taken to gather data from six nurseries, combining observation at the nurseries with interviews with owners and or managers (10), cooks (6), staff (12) and parents (2). The findings reveal the complex way different issues work together to support or hinder a nursery to develop a healthy eating culture and how relative inequalities, in general, are outworked. While recognising the importance of social status leading to poor health due to psychosocial stress, the findings tend to emphasise the importance of a strong welfare state and taking an early years of life-course approach in reducing health inequalities.

OP08 Evaluating the Health Inequalities Impact of the New Deal for Communities Initiative

Background New Deal for Communities (NDC), a 10-year area-based regeneration initiative begun in 1999 in 39 disadvantaged neighbourhoods in England, has the potential to reduce health inequalities because it focuses on key social determinants of these inequalities: unemployment, crime, education, housing and the physical environment. This study assesses whether the NDC initiative impacted on health inequalities across the socioeconomic spectrum of areas in England. Methods The study primarily utilises secondary data including household surveys undertaken as part of a national evaluation of the NDC initiative led by Sheffield University. Representative samples of 500 residents per NDC area and matched comparator area in 2002, 2004, 2006 and 2008 provide data on health, lifestyles, wellbeing, demography and social determinants of health. The Health Survey for England in the same years provides information for representative samples drawn from across the socioeconomic spectrum, here categorised as highest, middle and lowest tertile of area deprivation. Logistic regression was used to estimate baseline differences in health and its social determinants, the time trend and differential time trends in NDC and non-intervention areas adjusted for sex, age, ethnicity and baseline education based on over 125,000 observations across eight years. Outcomes of interest included self-rated health, mental health inventory, smoking, employment status and housing tenure. Results Initial analyses indicated a higher likelihood of smoking in non-intervention areas of medium deprivation (OR; 95%CI: 1.33; 1.10, 1.60), non-intervention areas of high deprivation (1.80; 1.48, 2.19), matched comparator areas (1.77; 1.46, 2.15) and NDC areas (1.97; 1.68, 2.31) compared with reference areas of low deprivation. Smoking declined over time but there was no evidence of differential rates of decline in the different areas. The likelihood of unemployment was considerably higher in all areas compared with the reference (for example, 4.29; 3.55, 5.18 in NDC areas). The likelihood of unemployment dropped over time in NDC areas but not in other areas (OR for time by NDC interaction: 0.93; 0.89, 0.96). Results for other outcomes are also available. Conclusion The study indicates that the NDC intervention may have contributed to reducing a key social determinant of health inequalities, namely unemployment. Similar reductions were not observed in non-intervention high, medium or low deprivation areas in England which may eventually feed through into a narrowing of health inequalities between NCD and other areas. This initial work will be extended to examine impact across different intervention approaches and historical and current contexts.

Socioeconomic deprivation and the burden of head and neck cancer-Regional variations of incidence and mortality in Merseyside and Cheshire, North West, England

The aim of this longitudinal study was to examine the distribution of head and neck cancer (HANC) disease burden across the region comparing it to national trends.

Protocol: systematic review of the association between socio-economic status and survival in adult head and neck cancer

BackgroundHead and neck cancer incidence is increasing worldwide. Despite overall improvements in survival, numerous studies suggest worse survival in more disadvantaged populations; however, this literature has not been systematically reviewed. The aim of this review is to investigate whether lower compared to higher socioeconomic status (SES) influences survival in head and neck squamous cell cancer (HNSCC) and explore possible explanations for any relationship found.MethodA systematic strategy will be used to identify articles, appraise their quality and extract data. Online databases including MEDLINE, Web of Knowledge, ESBCO Host and Scopus will be used to locate observational studies of adults with a primary diagnosis of head and neck cancer in EU15+ countries (15 members of the EU, Australia, Canada, Norway, USA and New Zealand) where the outcomes report associations between SES and survival. This will be augmented by searching for grey literature and through reference lists. Data will be extracted using a standardised form. Study quality will be assessed using the Newcastle Ottawa scale and where possible meta-analysis of the pooled data will be conducted.DiscussionThis review will quantify the association between SES and survival outcomes for adult head and neck cancer patients in developed countries. The results will help identify gaps in the literature and therefore direct further novel research in the field. Ultimately, this will inform public policy and strategies to reduce the inequalities in HNSCC survival.Systematic review registrationPROSPERO CRD42016037019.