̽��ֱ�� of Cambridge - John Ford

Experts urge government to keep focus on levelling-up health

cjb250 — Fri, 30 Sep 2022 10:32:46 +0000

Writing in Public Health in Practice and based on a review of all the previous literature, the team sets out a five-point framework to help level-up health and tackle health inequalities, which they say have been exacerbated by the COVID-19 pandemic.

̽��ֱ��UK Government committed to a programme of ‘levelling-up’ to help left-behind areas and regions to recover and prosper to the same extent as other parts of the country, including a £4.8 billion Levelling Up Fund. With the departure of Boris Johnson as Prime Minister, the researchers urge the new Government to reaffirm their commitment to levelling up.

With the fallout from the pandemic and rise in the cost of living, the impact on health is expected to be substantial due to the long-term economic repercussions of the pandemic, including food and housing insecurity, debt, and poverty.

Dr John Ford from Cambridge Public Health at the ̽��ֱ�� of Cambridge said: “It feels like we’re at a pivotal point as the Government moves its focus away from levelling-up and towards economic growth. It’s crucial that they consider closing the health gap – which has only got worse during the pandemic – as an urgent priority.

“This will not be straightforward to achieve and will require cross-government – and cross-party – support and long-term planning. That’s why we’re setting out five evidence-based principles that will help ensure the success of any health levelling-up programmes.”

Dr Ford and colleagues carried out a review of the research literature to develop a practical, evidence-based framework to level up health that can be implemented across sectors, including governments or non-profits, and across a diversity of scales, from local to national, and a diversity of contexts.

̽��ֱ��five overlapping principles identified by the group are:

Make interventions healthy by default and easy to use – In other words, make healthy choices easier to make. Past examples that have proven successful include: taxing unhealthy foods and subsidising healthy foods was consistently documented as an intervention type; providing fluoride toothpaste for home use and daily toothbrushing supervision for 5-year-olds.
Focus on long-term solutions working across many sectors – For example, while tackling housing conditions may be important, this alone is unlikely to be effective when individuals are still impacted by other factors such as working conditions or access to healthy foods: housing interventions are more likely to be effective in improving health and reducing inequalities when there were multiple interventions targeting several social determinants of health.
Tailor initiatives at a local level – For example, flu vaccination programmes are likely to be more successful if they can be offered outside of traditional working hours, while including community-based infrastructure developments in physical activity interventions can make them more sustainable, maintain increased adult physical activity levels and reduce inequalities.
Target disadvantaged communities – Universally-applied programmes that do not also target disadvantaged communities or account for their particular needs, assets, and barriers to health are less effective in reducing health inequalities and may even widen them. Provision of benefits to disadvantaged groups may also reduce health inequalities, such as food subsidy programmes for women of low-socioeconomic status that aim to reduce inequalities in mean birth weight and food/nutrient uptake.
Allocate resources according to need – Studies have shown that allocating resources where they are most needed – for example, the allocation of NHS resources proportionate to geographic need, with more deprived areas receiving more resources – is most effective at reducing inequalities.

Professor Clare Bambra from Newcastle ̽��ֱ�� said: “Health inequalities have arisen over decades, if not centuries, but underlying them is often the same root cause: an unequal distribution of the wider determinants of health, such as access to resources, opportunities, wealth, education, and power.

“There is no silver bullet that will solve this problem. If we are serious about tacking this problem, then we’ll need a holistic approach, with long-term, collaborative and cross-government strategies that look beyond just one election cycle.”

̽��ֱ��research was commissioned by Public Health England and undertaken in collaboration with Newcastle ̽��ֱ��.

Reference
Davey, F et al. Levelling up health: A practical, evidence-based framework for reducing health inequalities. Public Health in Practice; 30 Sept 2022; DOI: 10.1016/j.puhip.2022.100322

Experts are calling on the Government to continue focusing on ‘levelling-up’ health, arguing that reducing the health gap is too important an agenda to abandon.

It’s crucial that the government considers closing the health gap – which has only got worse during the pandemic – as an urgent priority

John Ford

Richard Johnson (Getty Images)

High-rise council flats in housing estate in Port Glasgow, Inverclyde

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Public health experts urge government to put health at centre of levelling up agenda

cjb250 — Fri, 10 Dec 2021 00:01:22 +0000

Based on decades of research around tackling health inequalities at local and regional level, the guidance is aimed at central and local government as well as other agencies with a stake in improving health.

̽��ֱ��team has published its report on the Cambridge Research Methods Hub website. It sets out five principles and eight policy recommendations that are designed to be used together long-term across national, regional and local systems.

̽��ֱ��principles are:

Allocating resources proportionate to need;
Working in partnership with local communities;
Developing long-term, multisector and cross-government programmes;
Offering bespoke services to disadvantaged groups;
Ensuring initiatives are healthy-by-default and easy to use.

Each principle is supported by case studies, such as Healthy New Towns, the Big Local initiative, and New Deal for Communities.

Dr John Ford, lead author and Clinical Lecturer in Public Health at the Primary Care Unit, ̽��ֱ�� of Cambridge, said: “ ̽��ֱ��new guidance has been produced to show how to level up health. We already know that progress on closing the gap is possible. ̽��ֱ��previous cross-government health inequalities programme reduced the socio-economic gap in life expectancy by six months and improved overall life expectancy. This was achieved through sustained, multi-component, and cross-government action over more than 10 years.”

Policy recommendations include: health being a core part of levelling up; development of a cross-government health inequalities strategy; establishing a consensus around what levelling up health means; and a focus on the social and structural factors that determine health.

Importantly, the report recommends a move away from initiatives that require individuals to invest time and effort to benefit from, such as promoting gym membership, because they tend to increase inequalities. Rather, the researchers recommend initiatives that make healthy choices the default and require minimal effort from the individuals, such as fluoridation of water and opportunistic screening for health problems during vaccine appointments.

Furthermore, the report calls for an end to competitive bidding of local areas to allocate public funds. Instead, it recommends allocating funding based on population need.

Health inequalities in England mean that men and women in deprived areas live an average of ten and eight years less respectively than men and women in more affluent places. Area-level health inequalities like these are driven by the conditions in which we live. Education and employment opportunities, housing, opportunities for exercise and a good diet are just some of the factors that directly affect our health.

Left-behind neighbourhoods, which have not prospered as much as other areas, experience greater health inequalities and the health of disadvantaged areas in the Northern regions has been falling further behind. For example, a baby boy born today in Blackpool can expect an additional 17 years of poor health compared to a baby boy born in Richmond upon Thames.

̽��ֱ��pandemic has exacerbated inequalities, and deaths related to COVID-19 in the most deprived areas of the country are double those in the least deprived. ̽��ֱ��long-term repercussions of the pandemic for some people – food and housing insecurity, debt and poverty – are expected to disproportionally affect those living in areas of higher deprivation, causing further damage to wellbeing and health.

̽��ֱ��researchers say that work to address area-level health inequalities is critically important for the UK Government’s levelling up agenda.

̽��ֱ��team reviewed data from over 650 research studies and 19 published reports. ̽��ֱ��12 case studies were selected from 143 potentially relevant examples from across England showing what works.

Professor Clare Bambra, Professor of Public Health at the ̽��ֱ�� of Newcastle, said: “Levelling up needs to urgently focus on health inequalities by addressing the unequal conditions in which we live, work and age.

“For too long, a lack of investment in key services has meant that more deprived, ‘Left Behind Areas’ – particularly in the north – have suffered disproportionately. ̽��ֱ��COVID-19 pandemic has worsened these inequalities and it will cast a long shadow across our future heath and economic prosperity as a country unless we act now. That’s why levelling up health is so central to the government’s overall approach to levelling up the country.”

̽��ֱ��new guidance was commissioned by Public Health England.

Reference
John Ford, Vic McGowan, Fiona Davey, Jack Birch, Isla Kuhn, Anwesha Lahiri, Anna Gkiouleka, Ananya Arora, Sarah Sowden, Clare Bambra. Levelling Up Health: A practical, evidence-based framework. December 2021

Health needs to be at the heart of the Government’s levelling up agenda, say researchers at the Universities of Cambridge and Newcastle. ̽��ֱ��team have today published practical guidance on how to reduce health inequalities.

̽��ֱ��new guidance has been produced to show how to level up health. We already know that progress on closing the gap is possible

John Ford

Francis Heathcote

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Worsening GP shortages in disadvantaged areas likely to widen health inequalities

cjb250 — Wed, 18 Aug 2021 07:43:55 +0000

In a study published today in the BJGP Open, a team from the ̽��ֱ�� of Cambridge looked at the relationship between shortages in the healthcare workforce and levels of deprivation. ̽��ֱ��team found significantly fewer full time equivalent (FTE) GPs per 10,000 patients in practices within areas of higher levels of deprivation. This inequality has widened slightly over time. By December 2020, there were on average 1.4 fewer FTE GPs per 10,000 patients in the most deprived areas compared to the least deprived areas.

̽��ֱ��same was the case for total direct patient care staff (all patient-facing general practice staff excluding GPs and nurses), with 1.5 fewer FTE staff per 10,000 patients in the most deprived areas compared to the least deprived areas.

̽��ֱ��lower GP numbers in deprived areas, was compensated, in part, by more nurses.

̽��ֱ��analysis used data captured between September 2015 and December 2020 from the NHS Digital General Practice Workforce collection. They compared this workforce data against practice population sizes and levels of deprivation across England.

In addition to their report, the team have today launched an interactive dashboard that maps local-level primary care workforce inequalities to accompany the national-level analysis done in the paper. Clear local-level inequalities in GP distribution can be seen within West, North and East Cumbria, Humber, Coast and Vale, and Coventry and Warwickshire STP (Sustainability and Transformation Plan) areas, among others.

Workforce shortages, especially in primary care, have been a problem for health care systems for some time now, and the gap between the growing demand for services and sufficient staff has been widening. Although the number of consultations in general practice has been increasing, staff numbers have not kept up with demand. ̽��ֱ��number of GPs relative to the size of population has been decreasing since 2009, and the GP workforce is ageing. Doctors are increasingly working part-time, which suggests that shortages will grow steadily worse.

In 2015, then-Secretary of State for Health Jeremy Hunt promised an additional 5,000 GPs for the NHS by 2020, but this was not achieved. Instead, it is predicted that there will be a shortage of 7,000 GPs by 2024.

Dr John Ford from the Department of Public Health and Primary Care at the ̽��ֱ�� of Cambridge, the study’s senior author, said: “People who live in disadvantaged regions of England are not only more likely to have long-term health problems, but are likely to find it even more difficult to see a GP and experience worse care when they see a GP. This is just one aspect of how disadvantage accumulates for some people leading to poor health and early death.

“There may be some compensation due to increasing number of other health professionals, which may partially alleviate the undersupply of GPs in more socioeconomically disadvantaged areas. But this is not a like-for-like replacement and it is unlikely to be enough.”

̽��ֱ��researchers say there are a number of reasons that may account for why GP workforce shortages disproportionately affect practices in areas of higher deprivation. Previous studies have suggested that the primary driver of GP inequality was the opening and closing of practices in more disadvantaged areas, with practice closures increasing in recent years.

Claire Nussbaum, the study’s first author, added: “ ̽��ֱ��government has made reducing health inequalities a core commitment, but this will be challenging with the increasing shortage of GPs in areas of high socioeconomic disadvantage, where health needs are greatest. ̽��ֱ��primary care staffing inequalities we observed are especially concerning, as they suggest that access to care is becoming increasingly limited where health needs are greatest.

“Addressing barriers to health care access is even more urgent in the context of COVID-19, which has widened pre-existing health and social inequities.”

̽��ֱ��researchers say that the imbalance in recruitment of staff within primary care must be addressed by policymakers, who will need to consider why practices and networks in disadvantaged areas are relatively under-staffed, and how this can be reversed. Potential options include increased recruitment to medical school from disadvantaged areas, incentivisation of direct patient care posts in under-staffed areas, enhanced training offers for these roles, and offering practices and networks in under-staffed areas additional recruitment support.

Expanded use of additional roles under the Additional Roles Reimbursement Scheme, designed to provide financial reimbursement for Primary Care Networks to build workforce capacity, may partially alleviate GP workload in overstretched practices, but the report’s authors argue that there is a risk that additional workforce will gravitate to more affluent areas, further perpetuating inequity in primary care staffing.

Dr James Matheson, a GP at Hill Top Surgery in Oldham, said: "People living in socioeconomically disadvantaged areas shoulder a much higher burden of physical and mental health problems but have less access to the GPs who could support them towards better health. For the primary care teams looking after them this means a greater workload with fewer resources - a burnout risk which can further exacerbate the problem.

“General Practice in disadvantaged areas is challenging but also enjoyable and professionally rewarding but now, more than ever, we need to see a more equitable distribution of workforce and resources to ensure it is sustainable."

Reference
Nussbaum, C et al. Inequalities in the distribution of the general practice workforce in England. BJGP Open; 18 Aug 2021; DOI: 10.3399/BJGPO.2021.0066

Areas of high socioeconomic disadvantage are being worst hit by shortages of GPs, a trend that is only worsening with time and is likely to widen pre-existing health inequalities, say researchers at the ̽��ֱ�� of Cambridge.

̽��ֱ��government has made reducing health inequalities a core commitment, but this will be challenging with the increasing shortage of GPs in areas of high socioeconomic disadvantage, where health needs are greatest

Claire Nussbaum

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