Housing, care and health infographics

King’s Fund. Published online: 14th April.

As part of a joint learning network on integrated housing, care and health, The King’s Fund and the National Housing Federation have produced a set of slides illustrating the connections between housing, social care, health and wellbeing.

Please feel free to use them in your office, in documents or presentations.

 

Implementing mental health policy: some lessons from recent history

Last year, Centre for Mental Health was commissioned by NHS England to help the Mental Health Taskforce to explore what helps and what hinders the implementation of policies and strategies relating to mental health in England.

From a review of literature and interviews and focus groups with people who have been responsible for policy implementation over the last 20 years, we identified 12 factors that influence the implementation of strategies. They are:

mental health policy.png
Image source: Centre for Mental Health

Read the full report here

Read the full commentary here

 

Uniting to end TB in England

On March 24th, Public Health England (PHE) celebrated world TB day by detailing the strong progress made towards implementing the national strategy in collaboration with NHS England and other major stakeholders.

TB
Image source: https://www.gov.uk/

One year ago, PHE and NHS England jointly launched the 5-year strategy to eliminate TB as a public health problem, and announced an £11.5 million investment as part of a collaborative initiative to decrease TB cases and reduce health inequalities.

A significant step has been the formation of 7 regional TB control boards across England, which bring together PHE, local authority public health, the NHS, NHS England, local commissioners and charities to work collaboratively to control TB in their area, ‘uniting to end TB’.

A key intervention from NHS England and PHE was the launch of a fully funded national testing and treatment programme for latent TB infection for persons who recently arrived from areas of the world where TB is common.

All 59 of the high TB burden areas in England have now signed up to this programme, which is based on evidence that treatment of people with dormant (‘latent’) TB prevents progression to the active TB disease.

NHS England have announced that they are providing a further £10 million to fund on-going testing and treatment programmes for latent TB infection in new entrants in the next year.

Read more here

Additional information: Public Health England  have published a new leaflet ‘Tuberculosis: the disease, its treatment and prevention’.

See the leaflet here:

 

Primary Care Corner with Geoffrey Modest MD: Abrupt vs. Gradual Smoking Cessation

BMJ Evidence-Based Medicine blog. Published online: 28th March 2016

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Image source: Alex Williamson – Wellcome Images // CC BY-NC-ND 4.0

An English study tested two strategies to achieve smoking cessation: a gradual vs abrupt approach (see doi:10.7326/M14-2805). The background is that most guidelines recommend abrupt cessation (“setting a quit date and then stopping cold turkey”), though many smokers report stopping more gradually.

Results, comparing the gradual vs abrupt quit rates:

  • At 4 weeks, 39.2% (34.0-44.4%) vs 49.0% (43.8-54.2%); RR 0.80 (0.66-0.93)
  • At 6 months, 15.5% (12.0-19.7%) vs 22.0% (18.0-26.6%); RR 0.71 (0.446-0.91)
  • Fewer people made a quit attempt (>24 hours of self-reported abstinence) in the gradual cessation group (61.4% vs 71% in the abrupt group; though in the gradual group, they had reduced their cigarette consumption by 48% by the end of the first pre-cessation week (target 50%) and by 68% by the end of the second week (target 75%)
  • ​And, participants who preferred gradual vs abrupt cessation prior to randomization were less likely to be abstinent at 4 weeks (38.3% vs 52.2%)
  • No significant study-related adverse events

Read the full analysis here

 

Behavioural factors in person and community-centred approaches to health and wellbeing

The Health Foundation has published ‘Making the change: Behavioural factors in person- and community-centred approaches for health and wellbeing’.

Making the Change report
Image source: http://www.health.org.uk/

Drawing on studies of what influences behaviour, this report sets out a number of factors that can lead to greater involvement in self-care.  It provides a framework for understanding the drivers of behaviour and includes examples and case studies to illustrate how the theories work in practice.

This report provides an accessible introduction to the theories of change behind a series of action-focused guides that will be published as part of the Realising the Value programme in Autumn 2016.

It is aimed at policymakers, commissioners, service designers and organisations working to promote more person- and community-centered approaches for health and wellbeing.

Read more here

New PHE data on salt consumption levels

The National Diet and Nutrition Survey (NDNS) shows that on average adults are eating 8 grams of salt per day.

PHE salt intake
Image source: PHE

Adults have cut their average salt consumption by 0.9 grams per day in the decade from 2005 to 2014 according to new data from Public Health England’s National Diet and Nutrition Survey.

Average salt consumption for adults in 2014 was 8.0 grams per day. This has decreased from 8.5 grams in 2011 and 8.8 grams in 2005/06. Overall salt intake has fallen by 11% since the 2005 to 2006 survey.

Public Health England commissioned an assessment of the salt content of 24-hour urine collections made from May to September 2014. A random sample of 689 adults aged 19 to 64 years, designed to be representative of adults in England, took part in the study.

This report continues the series of urinary sodium surveys across the general adult population in United Kingdom countries since 2005/06. The results are used by government to monitor progress towards the recommended maximum salt intake for adults of no more than 6 grams per person per day.

Read more here

A new approach to tackling Type 2 diabetes is a step forward for prevention

Fenton, K. PHE Blog. Published online:22 March 2016.

healthieryou_logo_rgb
Image source: PHE 

As waistlines continue to expand across the country (62% of adults are overweight or obese), diagnoses of Type 2 diabetes are also rising. The cost of treating diabetes, and associated complications such as heart disease and stroke, is costing the NHS around £10bn every year.

Trends are only going one way – with one in ten adults expected to be diagnosed with Type 2 diabetes by 2034.

The programme aims to identify those at high risk and refer them into evidence-based behavioural interventions to help them reduce that risk through achieving and/or maintaining a healthy weight, recommended levels of activity and a healthy, balanced diet.

We published a systematic review in August last year that examined the effectiveness of ‘real-world’ interventions for the prevention of Type 2 diabetes in high risk populations. The review looked closely at the following areas:

  • The effectiveness of diabetes prevention programmes on reducing cases of Type 2 diabetes and reducing weight in high risk populations
  • The population groups that see the greatest effect from diabetes prevention programmes by age, gender, body mass index (BMI) and ethnicity
  • The key elements that might constitute a successful diabetes prevention programme

Data from 36 studies were included in this review, which revealed an average 26% reduction in new cases of Type 2 diabetes in those participating in a diabetes prevention programme, compared with usual care, although some studies achieved greater reductions. The strongest elements of the programmes we studied (for example, a greater number of sessions over a longer period of time) have been taken forward into our programme.

Read the full blog post here

Health matters: Your dementia risk reduction toolkit

Public Health England Blog

green
Image source: PHE

We hope that through the breadth of ‘Health Matters – Midlife approaches to reduce dementia risk’ content, we have made the case for investment of time and money in dementia prevention, but a question may remain; what tools and resources are available to support professionals in making an impact?

NICE guidance on midlife approaches to delay/prevent dementia

NICE have produced guidance covering mid-life approached to delay or prevent the onset of dementia, disability and frailty in later life. It aims to increase the amount of time that people can be independent, healthy and active.

View the full toolkit here

Association between subjective social status and cardiovascular disease and cardiovascular risk factors

Tang, K.L. et al. BMJ Open 2016;6:e010137

social hierarchy.png

Objective: To determine the association between subjective social status (SSS), or the individual’s perception of his or her position in the social hierarchy, and the odds of coronary artery disease (CAD), hypertension, diabetes, obesity and dyslipidaemia.

Study Design: Systematic review and meta-analysis.

Methods: We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, SocINDEX, Web of Science and reference lists of all included studies up to October 2014, with a verification search in July 2015. Inclusion criteria were original studies in adults that reported odds, risk or hazard ratios of at least one outcome of interest (CAD, hypertension, diabetes, obesity or dyslipidaemia), comparing ‘lower’ versus ‘higher’ SSS groups, where SSS is measured on a self-anchoring ladder. ORs were pooled using a random-effects model.

Results: 10 studies were included in the systematic review; 9 of these were included in the meta-analysis. In analyses unadjusted for objective socioeconomic status (SES) measures such as income, education or occupation, the pooled OR comparing the bottom versus the top of the SSS ladder was 1.82 (95% CI 1.10 to 2.99) for CAD, 1.88 (95% CI 1.27 to 2.79) for hypertension, 1.90 (95% CI 1.25 to 2.87) for diabetes, 3.68 (95% CI 2.03 to 6.64) for dyslipidaemia and 1.57 (95% CI 0.95 to 2.59) for obesity. These associations were attenuated when adjusting for objective SES measures, with the only statistically significant association remaining for dyslipidaemia (OR 2.10, 95% CI 1.09 to 4.06), though all ORs remained greater than 1.

Conclusions: Lower SSS is associated with significantly increased odds of CAD, hypertension, diabetes and dyslipidaemia, with a trend towards increased odds of obesity. These trends are consistently present, though the effects attenuated when adjusting for SES, suggesting that perception of one’s own status on a social hierarchy has health effects above and beyond one’s actual income, occupation and education.

Read the full article here

Towards a prosperous, poverty free Wales

The Joseph Rowntree Foundation has published a manifesto briefing that sets out a number of key actions for the next Assembly and Welsh Government to consider in order to reduce poverty in Wales.

JRF Poverty free Wales
Image source: https://www.jrf.org.uk/

Key recommendations include:

  • A suggested, achievable, target to reduce poverty. Currently, 700,000 people in Wales are in relative income poverty. Taking action across all sectors could reduce this to 600,000 by the end of the fifth Assembly in 2021.
  • Multi-dimensional action to tackle drivers of poverty relating to the jobs market, housing, childcare, education, the benefits system and the cost of essential goods and services.
  • Reforming the early years and childcare systems, and refreshing attempts to close the educational attainment gap in schools.
  • Helping young people to move successfully into work, ensuring that more and better jobs are created.
  • Improving support for older people with healthcare needs and improving benefit take-up among older people.

Read more here: