Diet-related health problems are rarely out of the news. That’s because so many illnesses and diseases are the result of poor diet. There’s no shortage of suggestions for improving our diet, and for educating all of us on the benefits of eating well.
Policymakers are also concerned about this issue. Since the start of the COVID-19 pandemic, the NHS has been under greater pressure than ever, and government has been keen to address diet-related health problems.
Examples of this include the most recent legislation to add calorie labelling to restaurants and takeaways, which has been controversial. The new rules for England make it a legal requirement for large businesses with more than 250 employees, including cafes, restaurants and takeaways, to display calorie information of non-prepacked food and soft drinks. The Scottish Government is consulting on similar proposals.
Sugar and salt taxes
Another example of regulations directed towards diet-related health problems would be taxes on sugar and salt in foods. There have been suggestions to either tax all foods based on their salt content, or specific foods which are classed as “high” in salt.
A sugar tax – the Soft Drinks Industry Levy – was introduced in April 2018 by the UK Government. It was later reported that consumers had bought 10% less sugar through soft drinks, which will also have lowered risks of obesity, type 2 diabetes and high blood pressure.
A report from the Institute of Fiscal Studies in 2021, looked at the impacts a tax on added sugar and salt could have on purchases of food both at home and out of the home in the UK. The report found that a salt tax could potentially see a decrease in risks of coronary heart disease and strokes.
In addition, the study suggested a salt tax could reduce the number of NHS treatments for obesity-related conditions, resulting in lower NHS costs. The report also indicated an increase in overall economic output due to a healthier workforce.
However, there may also be less welcome consequences. A ‘snack tax’ has been estimated to potentially add as much as £3.4billion a year to families’ shopping bills. Introducing such a tax during the current cost of living crisis would add greatly to the financial stresses being experienced by households across the country.
Counting the calories
Displaying the number of calories in meals on menus has long been proposed as a way to tackle obesity and health issues, as so many people are unaware of just what is in the food they order. Public opinion is extremely divided on this subject, with some being in favour of this extra measure to help them when eating out if they wish to make healthier choices.
However, adding calorie information to menus may have undesirable effects. 1.25 million people in the United Kingdom have an eating disorder, and the COVID-19 pandemic is likely to have increased this number as more people struggle with mental illness and increased stress.
Beat, a UK-based eating disorder charity, has highlighted that calorie labelling exacerbates eating disorders of all kinds. In addition, pushing a “diet culture” could send the wrong messages about eating rather than embracing a more positive approach towards food.
A further study by the British Medical Journal reported only a small decrease in calories purchased when trialling calorie labelling in three chain restaurants in the United States. The researchers also found that after one year, that reduction diminished.
Meeting in the middle?
Another suggestion that has been discussed is tackling health-related inequalities, and understanding why certain groups are more vulnerable to these issues than others. For example, the House of Commons library has reported that in England people living in the most deprived areas were 9% more likely to be overweight or obese than those in the least deprived areas. The briefing also reported that children in the most deprived areas of England were twice as likely to be obese.. More education focusing on not only what is healthy food, but how to be healthy with fewer resources could help reduce such inequalities.
Final thoughts
From tooth decay and high blood pressure to cancer, eating disorders and mental ill health, there are significant health and wellbeing impacts resulting from unhealthy eating habits. These issues also have serious consequences for healthcare services.
As we’ve seen, legislation has already been introduced to tackle diet-related health problems. But it’s likely that government will have to consider further measures to ensure that the food that we eat is both good for individuals and for wider society.
Further reading: more on food and nutrition from The Knowledge Exchange blog
A stretch of the Champs-Élysées around the Arc de Triomphe in Paris is due to be pedestrianised by 2030. Shutterstock
Answer: the vehicles on our streets, primarily the not-so-humble passenger car.
Despite the (slow) migration to electric-powered cars, consumer trends are making driving even more wasteful and unequal. A recent analysis found the emissions saved from electric cars have been more than cancelled out by the increase in gas-guzzling Sport Utility Vehicles (SUVs). Around the world, SUVs alone emit more carbon pollution than Canada or Germany, and are causing a bigger increase in climate pollution than heavy industry.
While cars are sometimes necessary for people’s mobility and social inclusion needs – not least those with disabilities – car-centric cities particularly disadvantage the already-marginalised. In the UK, women, young and older people, those from minority communities and disabled people are concentrated in the lowest-income households, of which 40% do not have a car. In contrast, nearly 90% of the highest-income households own at least one car.
So the driving habits of a minority impose high costs on society, and this is especially true in cities. Copenhagen, for example, has calculated that whereas each kilometre cycled benefits society to the tune of €0.64 (53 pence), each kilometre driven incurs a net loss of -€0.71 (-59p), when impacts on individual wellbeing (physical and mental health, accidents, traffic) and the environment (climate, air and noise pollution) are accounted for. So each kilometre travelled where a car is replaced by a bicycle generates €1.35 (£1.12) of social benefits – of which only a few cents would be saved by switching from a fossil-fuelled to an electric-powered car, according to this analysis.
Reducing car use in cities
Half a century ago, the Danish capital was dominated by cars. But following grassroots campaigns to change policies and streets, including replacing car parking with safe, separated bike lanes, Copenhagen has increased its biking share of all trips from 10% in 1970 to 35% today. In 2016, for the first time, more bicycles than cars made journeys around the city over the course of that year.
Bicycles rule the centre of Copenhagen following campaigns to replace parking with safe bike lanes. Shutterstock
But while many other car-limiting initiatives have been attempted around the world, city officials, planners and citizens still do not have a clear, evidence-based way to reduce car use in cities. Our latest research, carried out with Paula Kuss at the Lund University Centre for Sustainability Studies and published in Case Studies on Transport Policy, seeks to address this by quantifying the effectiveness of different initiatives to reduce urban car use.
Our study ranks the 12 most effective measures that European cities have introduced in recent decades, based on real-world data on innovations ranging from the “carrot” of bike and walk-to-work schemes to the “stick” of removing free parking. The ranking reflects cities’ successes not only in terms of measurable reductions in car use, but in achieving improved quality of life and sustainable mobility for their residents.
In all, we have screened nearly 800 peer-reviewed reports and case studies from throughout Europe, published since 2010, seeking those that quantified where and how cities had successfully reduced car use. The most effective measures, according to our review, are introducing a congestion charge, which reduces urban car levels by anywhere from 12% to 33%, and creating car-free streets and separated bike lanes, which has been found to lower car use in city centres by up to 20%. Our full ranking of the top 12 car-reducing measures is summarised in this table: https://datawrapper.dwcdn.net/NDMp4/12/
The inequality of car use
Cars are inherently inefficient and inequitable in their use of land and resources. On average, they spend 96% of their time parked, taking up valuable urban space that could be put to more beneficial uses such as housing and public parks. In Berlin, car users on average take up 3.5 times more public space than non-car users, primarily through on-street parking.
And it is overwhelmingly richer people who drive the most: in Europe, the top 1% by income drive nearly four times more than the median driver, accounting for some 21% of their personal climate footprint. For these highest emitters, climate pollution from driving is second only to flying (which, on average, generates twice as many emissions).
Prioritising cars as a means of transport also favours suburban sprawl. City suburbs typically possess larger homes that generate higher levels of consumption and energy use. North American suburban households consistently have higher carbon footprints than urban ones: one study in Toronto found suburban footprints were twice as high.
It’s also clear that road traffic levels swell to fill the size of the roads built – yet traffic planning routinely ignores the fact that this “induced demand” exaggerates the benefits and underestimates the costs of building more roads.
Electric vehicles are necessary, but they’re not a panacea. Since cars tend to be on the road for a long time, the migration to electric vehicles is very slow. Some studies anticipate relatively small emissions reductions over the coming decade as a result of electric vehicle uptake. And even if there’s nothing damaging released from an electric car’s exhaust pipe, the wear of car brakes and tyres still creates toxic dust and microplastic pollution. However a car is powered, can it ever be an efficient use of resources and space to spend up to 95% of that energy moving the weight of the vehicle itself, rather than its passengers and goods?
COVID-19: a missed opportunity?
Our study assesses urban mobility innovations and experiments introduced before the pandemic was declared. In response to COVID-19, travel habits (to begin with, at least) changed dramatically. But following large reductions in driving during the spring of 2020, road use and the associated levels of climate pollution have since rebounded to near pre-pandemic levels. Indeed, in Sweden, while public transport use declined by around 42% during the first year of the pandemic, car travel declined by only 7% in the same period, leading to an overall increase in the proportion of car use.
Commuter traffic in Stockholm in November 2021. Sweden has seen an overall increase in its proportion of car use during the pandemic. Shutterstock
While entrenched habits such as car commuting are hard to shift, times of disruption can offer an effective moment to change mobility behaviour – in part because people forced to try a new habit may discover it has unexpected advantages. For such behaviour to stick, however, also requires changes in the physical infrastructure of cities. Unfortunately, while European cities that added pop-up bike lanes during the pandemic increased cycling rates by a stunning 11-48%, we are now seeing a return to car-centric cities, with extra car lanes and parking spaces once again displacing cycle lanes and space for pedestrians.
Overall, the opportunities to align pandemic recovery measures with climate targets have largely been squandered. Less than 20% of government spending on pandemic measures globally were likely to also reduce greenhouse gas emissions.
The extent to which workers resume driving to their offices is another key issue determining future car use in cities. Thoughtful travel policies to reduce unnecessary travel, and opportunities for faraway participants to fully participate in meetings and conferences digitally, could slash emissions by up to 94% – and save time to boot. Those who work remotely three or more days per week travel less overall than their peers. But long car commutes can quickly wipe out such emissions savings, so living close to work is still the best option.
No silver bullet solution
The research is clear: to improve health outcomes, meet climate targets and create more liveable cities, reducing car use should be an urgent priority. Yet many governments in the US and Europe continue to heavily subsidise driving through a combination of incentives such as subsidies for fossil fuel production, tax allowances for commuting by car, and incentives for company cars that promote driving over other means of transport. Essentially, such measures pay polluters while imposing the social costs on wider society.
City leaders have a wider range of policy instruments at their disposal than some might realise – from economic instruments such as charges and subsidies, to behavioural ones like providing feedback comparing individuals’ travel decisions with their peers’. Our study found that more than 75% of the urban innovations that have successfully reduced car use were led by a local city government – and in particular, those that have proved most effective, such as congestion charges, parking and traffic controls, and limited traffic zones.
But an important insight from our study is that narrow policies don’t seem to be as effective – there is no “silver bullet” solution. The most successful cities typically combine a few different policy instruments, including both carrots that encourage more sustainable travel choices, and sticks that charge for, or restrict, driving and parking.
So here are the 12 best ways to reduce city car use:
1. Congestion charges
The most effective measure identified by our research entails drivers paying to enter the city centre, with the revenues generated going towards alternative means of sustainable transport. London, an early pioneer of this strategy, has reduced city centre traffic by a whopping 33% since the charge’s introduction by the city’s first elected mayor, Ken Livingstone, in February 2003. The fixed-charge fee (with exemptions for certain groups and vehicles) has been raised over time, from an initial £5 per day up to £15 since June 2020. Importantly, 80% of the revenues raised are used for public transport investments.
Other European cities have followed suit, adopting similar schemes after referenda in Milan, Stockholm and Gothenburg – with the Swedish cities varying their pricing by day and time. But despite congestion charges clearly leading to a significant and sustained reduction of car use and traffic volume, they cannot by themselves entirely eliminate the problem of congestion, which persists while the incentives and infrastructure favouring car use remain.
2. Parking and traffic controls
In a number of European cities, regulations to remove parking spaces and alter traffic routes – in many cases, replacing the space formerly dedicated to cars with car-free streets, bike lanes and walkways – has proved highly successful. For example, Oslo’s replacement of parking spaces with walkable car-free streets and bike lanes was found to have reduced car usage in the centre of the Norwegian capital by up to 19%.
3. Limited traffic zones
Rome, traditionally one of Europe’s most congested cities, has shifted the balance towards greater use of public transport by restricting car entry to its centre at certain times of day to residents only, plus those who pay an annual fee. This policy has reduced car traffic in the Italian capital by 20% during the restricted hours, and 10% even during unrestricted hours when all cars can visit the centre. The violation fines are used to finance Rome’s public transport system.
4. Mobility services for commuters
The most effective carrot-only measure identified by our review is a campaign to provide mobility services for commuters in the Dutch city of Utrecht. Local government and private companies collaborated to provide free public transport passes to employees, combined with a private shuttle bus to connect transit stops with workplaces. This programme, promoted through a marketing and communication plan, was found to have achieved a 37% reduction in the share of commuters travelling into the city centre by car.
5. Workplace parking charges
Another effective means of reducing the number of car commuters is to introduce workplace parking charges. For example, a large medical centre in the Dutch port city of Rotterdam achieved a 20-25% reduction in employee car commutes through a scheme that charged employees to park outside their offices, while also offering them the chance to “cash out” their parking spaces and use public transport instead. This scheme was found to be around three times more effective than a more extensive programme in the UK city of Nottingham, which applied a workplace parking charge to all major city employers possessing more than ten parking spaces. The revenue raised went towards supporting the Midlands city’s public transport network, including expansion of a tram line.
Norwich reduced car commuters by nearly 20% with its workplace travel plan, including swapping car for bike parking. Shutterstock
6. Workplace travel planning
Programmes providing company-wide travel strategies and advice to encourage employees to end their car commutes have been widely used in cities across Europe. A major study, published in 2010, assessing 20 cities across the UK found an average of 18% of commuters switched from car to another mode after a full range of measures were combined – including company shuttle buses, discounts for public transport and improved bike infrastructure – as well as reduced parking provision. In a different programme, Norwich achieved near-identical rates by adopting a comprehensive plan but without the discounts for public transport. These carrot-and-stick efforts appear to have been more effective than Brighton & Hove’s carrot-only approach of providing plans and infrastructure such as workplace bicycle storage, which saw a 3% shift away from car use.
7. University travel planning
Similarly, university travel programmes often combine the carrot of promotion of public transport and active travel with the stick of parking management on campus. The most successful example highlighted in our review was achieved by the University of Bristol, which reduced car use among its staff by 27% while providing them with improved bike infrastructure and public transport discounts. A more ambitious programme in the Spanish city of San Sebastián targeted both staff and students at Universidad del País Vasco. Although it achieved a more modest reduction rate of 7.2%, the absolute reduction in car use was still substantial from the entire population of university commuters.
8. Mobility services for universities
The Sicilian city of Catania used a carrot-only approach for its students. By offering them a free public transport pass and providing shuttle connections to campus, the city was found to have achieved a 24% decrease in the share of students commuting by car.
Catania achieved a 24% decrease in the share of students commuting by car. Shutterstock
9. Car sharing
Perhaps surprisingly, car sharing turns out to be a somewhat divisive measure for reducing car use in cities, according to our analysis. Such schemes, where members can easily rent a nearby vehicle for a few hours, have showed promising results in Bremen, Germany and Genoa, Italy, with each shared car replacing between 12 and 15 private vehicles, on average. Their approach included increasing the number of shared cars and stations, and integrating them with residential areas, public transport and bike infrastructure.
Both schemes also provided car sharing for employees and ran awareness-raising campaigns. But other studies point to a risk that car sharing may, in fact, induce previously car-free residents to increase their car use. We therefore recommend more research into how to design car sharing programmes that truly reduce overall car use.
10. School travel planning
Two English cities, Brighton & Hove and Norwich, have used (and assessed) the carrot-only measure of school travel planning: providing trip advice, planning and even events for students and parents to encourage them to walk, bike or carpool to school, along with providing improved bike infrastructure in their cities. Norwich found it was able to reduce the share of car use for school trips by 10.9%, using this approach, while Brighton’s analysis found the impact was about half that much.
11. Personalised travel plans
Many cities have experimented with personal travel analysis and plans for individual residents, including Marseille in France, Munich in Germany, Maastricht in the Netherlands and San Sebastián in Spain. These programmes – providing journey advice and planning for city residents to walk, bike or use (sometimes discounted) public transport – are found to have achieved modest-sounding reductions of 6-12%. However, since they encompass all residents of a city, as opposed to smaller populations of, say, commuters to school or the workplace, these approaches can still play a valuable role in reducing car use overall. (San Sebastián introduced both university and personalised travel planning in parallel, which is likely to have reduced car use further than either in isolation.)
12. Apps for sustainable mobility
Mobile phone technology has a growing role in strategies to reduce car use. The Italian city of Bologna, for example, developed an app for people and teams of employees from participating companies to track their mobility. Participants competed to gain points for walking, biking and using public transport, with local businesses offering these app users rewards for achieving points goals.
There is great interest in such gamification of sustainable mobility – and at first glance, the data from the Bologna app looks striking. An impressive 73% of users reported using their car “less”. But unlike other studies which measure the number or distance of car trips, it is not possible to calculate the reduction of distance travelled or emissions from this data, so the overall effectiveness is unclear. For example, skipping one short car trip and skipping a year of long driving commutes both count as driving “less”.
While mobility data from apps can offer valuable tools for improved transport planning and services, good design is needed to ensure that “smart” solutions actually decrease emissions and promote sustainable transport, because the current evidence is mixed. For instance, a 2021 study found that after a ride-hailing service such as Uber or Lyft enters an urban market, vehicle ownership increases – particularly in already car-dependent cities – and public transport use declines in high-income areas.
Cities need to re-imagine themselves
Reducing car dependency is not just a nice idea. It is essential for the survival of people and places around the world, which the recent IPCC report on climate impacts makes clear hinges on how close to 1.5°C the world can limit global warming. Avoiding irreversible harm and meeting their Paris Agreement obligations requires industrialised nations such as the UK and Sweden to reduce their emissions by 10-12% per year – about 1% every month.
Yet until the pandemic struck, transport emissions in Europe were steadily increasing. Indeed, current policies are predicted to deliver transport emissions in 2040 that are almost unchanged from 50 years earlier.
Local buses in the Swedish city of Lund, home of the Centre for Sustainability Studies. Shutterstock
To meet the planet’s health and climate goals, city governments need to make the necessary transitions for sustainable mobility by, first, avoiding the need for mobility (see Paris’s 15-minute city); second, shifting remaining mobility needs from cars to active and public transport wherever possible; and finally, improving the cars that remain to be zero-emission.
This transition must be fast and fair: city leaders and civil society need to engage citizens to build political legitimacy and momentum for these changes. Without widespread public buy-in to reduce cars, the EU’s commitment to deliver 100 climate-neutral cities in Europe by 2030 looks a remote prospect.
Radically reducing cars will make cities better places to live – and it can be done. A 2020 study demonstrated that we can provide decent living standards for the planet’s projected 10 billion people using 60% less energy than today. But to do so, wealthy countries need to build three times as much public transport infrastructure as they currently possess, and each person should limit their annual travel to between 5,000 kilometres (in dense cities) and 15,000 kilometres (in more remote areas).
The positive impact from reducing cars in cities will be felt by all who live and work in them, in the form of more convivial spaces. As a journalist visiting the newly car-free Belgian city of Ghent put it in 2020:
The air tastes better … People turn their streets into sitting rooms and extra gardens.
Cities need to re-imagine themselves by remaking what is possible to match what is necessary. At the heart of this, guided by better evidence of what works, they must do more to break free from cars.
While there has been a lot of conversation about the vulnerable over the last two years of the COVID-19 pandemic, and rightly so, there has not much attention given to the people who care for them, particularly the young people who do so. Young carers carry a lot on their shoulders, and this has only been increased with the impact of the pandemic affecting those they love. However, we also need to look out for these young people and give them the support they deserve.
Issues faced by young carers
Young carers are faced with many challenges due to their position and this can depend on the carers, their age, the level of care they give and who they care for. A report on siblings of disabled children from the UK charity Sibs found that the particular young carers they engaged with tended to not get as much attention and support from their parents because of their sibling needing more urgent care. Even something as simple as going out to play centres or restaurants must be adapted to fit the disabled sibling, with the carer sibling rarely getting their own choice.
Young carers have also been found to be at more risk of mental health problems than others, particularly if the person they are caring for is a parent with a mental illness or a history of substance misuse. A study from Scotland found that young carers, much like adult unpaid carers, were more likely to have physical health issues such as tiredness, backache and bad diets in addition to reporting worry, stress, anxiety, depression and resentment. They were also found to have significantly lower self-esteem and feelings of happiness than non-carers.
Impact of pandemic
The COVID-19 pandemic impacted young carers greatly. Sibs reported that a lot of parents felt their carer children were extremely worried about contracting the virus and giving it to their sibling, or bringing it into the household if their family were shielding or vulnerable. Others also reported their child withdrawing from friends, either because of shielding or simply because they were uncomfortable socialising outside of their household. Sibs also noted cases where siblings would become the object of their disabled sibling’s anger or frustration.
In addition, a lot of activities and support groups normally put into place for these specific carers, in order to give them attention and opportunities to enjoy life outside of their role as a young carer, were cancelled due to COVID-19, and left many young carers at home, where they were often ignored if their sibling or parent needed additional support.
Other young carers have had to take on a range of duties, including shopping for their families or taking care of their home or other siblings. A lot of these young people have had to balance this with continuing their education from home and dealing with having their lives outside of the home cut off due to social distancing and isolation. This is on top of the general struggles of growing up as a child and adolescent. Izzy, a 12-year-old interviewed by a study from the Centre for Research on Children and Families, said she felt her entire life was “being a mini adult, but it’s not a pick and choose the time sort of thing.”
Support
There have been a range of support services for young carers across the United Kingdom. Young carers groups have been found to be a great resource to help find other young carers and share some of the issues that affect them with people who understand. These groups are also important as an outlet outside of their role in the family home, providing support solely for young carers. Even during the pandemic, some groups were able to schedule calls for young carers which provided them with interaction just for them, and something to look forward to each week at home.
However, many young carers remain “hidden” from services, either out of choice or because they have been ignored. Some simply don’t know about support groups or services, or have been found to not consider themselves ‘carers’. Instead, they view their lives as “normal” or doing something that’s “expected” of them. Others may be afraid of the stigma their particular situation may bring them, and therefore want to be perceived as the same as their fellow students.
Final thoughts
The pandemic has pushed conversation and debate towards how we care for the most vulnerable in our society, and hopefully will lead to improvements in our attitudes towards care. However, this also has to extend towards unpaid carers, and particularly the young people who often shoulder invisible labour at the expense of their childhood.
Further reading: more from The Knowledge Exchange blog on carers
Almost from the start of the coronavirus (COVID-19) pandemic, its unequal impact on ethnic minorities has been clear. But the health inequalities experienced by Black, Asian and Minority Ethnic (BAME) communities predate the pandemic. As the Local Government Association has observed:
“…the truth is these inequalities were already having an impact on the health and wellbeing of ethnic minority communities before COVID-19 hit – it is just that the pandemic has shone a light on them like nothing before.”
The report mainly looked at the period from 1993 to 2017, although the webinar was able to offer more recent information regarding the COVID-19 pandemic, which of course greatly affected health inequalities.
Widening inequalities
Dr. Sarah Stopforth, one of the researchers for this study, explained that ethnic inequalities have been found to widen more after the age of 30, and by the age of 40 have established themselves. One of the study’s main findings was that poor health for White British women in their 80s was the equivalent to the poor health of African and Caribbean women in their 70s, and the equivalent to Pakistani and Bangladeshi women in their 50s.
While there were similar results for men from these same ethnic groups, it is clear that women across all ethnicities have poorer health than their male counterparts. Why is this happening?
The reasons are complex, but Sara suggested that health inequalities are usually tied to the socio-economic inequalities present in our society. However, she also said that this tends to ignore the underlying causes of these health outcomes.
The role of the NHS
Dr. Habib Naqvi from NHS England talked about the role of the NHS in tackling health inequalities. He asserted that our healthcare system should be well equipped to respond to these inequalities, given the UK’s long history of migration by people from Afro-Caribbean communities. So why has it not been able to?
A lot of this, he explained, was due to the fragmentation of the NHS. The many areas of the sector are not working co-operatively to reach a collective and consistent goal, which then affects the ability to tackle issues such as inequalities in the sector.
In addition, Dr Naqvi pointed to mortality rates for ethnic minority groups – living longer does not always mean living in a healthy way. One of the features of “long Covid,” is its tendency to exacerbate long-standing health complications or to weaken COVID-19 patients’ health even after the illness. Again, ethnic minority communities have been disproportionately affected by this condition.
Another impact of the COVID-19 pandemic has been a heightened feeling of isolation and fear for many ethnic minority groups, something highlighted in a report from the University of Manchester. Many were unable to communicate with healthcare staff due to language barriers or health conditions affecting their communication skills, and were often having to be admitted alone due to Covid restrictions. The inability of patients from ethnic minority backgrounds speak for themselves raises concerns about their healthcare. Research has found evidence that ethnic minority patients – especially women – are not having their illnesses taken seriously.
Vaccine hesitancy
Linked to this is the controversial issue of vaccine hesitancy, which has become a particular concern among ethnic minority groups. One of the reasons that many members of ethnic minorities may feel hesitant or scared to take the vaccination is because of the lack of communication and information, linked with their previous healthcare experiences.
It was suggested during the webinar that even throughout the pandemic, the healthcare sector has not effectively protected ethnic minorities, despite these health inequalities long being known. Health professionals have attempted to reach out to communities and help them with any fears regarding COVID-19 or the vaccination process, but this can be difficult with social distancing restrictions. As a result, people within BAME communities may have to rely on family and friends to get information regarding vaccination, which may not calm their fears.
Data, care and trust
One of the key points driven home by Dr. Naqvi was the need for better data in order to better understand health inequalities among ethnic minority communities. Birth to end-of-life care was also mentioned, including tackling racial bias that can be found even in antenatal care. Finally, the concept of earning trust was highlighted. Dr. Naqvi said that the NHS must work to earn trust from BAME communities, particularly among the elderly, given the long-standing disparities in treatment and discrimination many have faced over the years.
Final thoughts
The webinar offered useful insights into how deeply healthcare inequalities lie. Our previous blog post on the future of public health offered a reminder that access to efficient, well-supported and high quality healthcare is vital for everyone. This webinar underlined that message, but highlighted its special significance for those experiencing longstanding health inequalities.
The last few decades have seen increasing rates of mental health disorders among children and young people. But while children and young people’s mental health is currently high on the public agenda, many of these mental health conditions remain unrecognised and untreated.
The NHS conducted a Mental Health Survey for Children and Young People in 2017, interviewing 3,667 children and young people, which was followed up in 2021. The follow-up survey found that 39.2% of 6 to 16 year olds had experienced a decrease in their mental health since 2017, while approximately 52% of 17 to 23 year olds also reported a decrease. Within these last four years, a number of factors appear to have impacted these figures, including the continued rise and prominence of social media platforms, family life, and, of course, the Coronavirus (COVID-19) pandemic.
Impact of the pandemic
The beginning of the pandemic marked the closure of all schools, colleges and universities. Not only were young people faced with the anxiety and stress associated with living through a global pandemic, particularly for those who are immunocompromised or have family members who are, but these closures also cut off access to resources for mental health problems. A survey by YoungMinds in January 2021 found that among over 2000 participants who were under the age of 25 in the UK with a history of mental illness, 75% agreed that they were finding the current lockdown harder to cope with than the previous ones, and 67% believed that the pandemic will have a long-term negative effect on their mental health.
Peer support groups and face to face services such as counselling that could be accessed through school were closed, or made accessible through the internet or over the phone. While this does offer some kind of continued support, it is not a form of support that works for everyone and many young people were left feeling unsupported. The YoungMinds report emphasised that any future provision must recognise the value of face to face interaction alongside virtual and digital forms of support.
Alongside issues with access to support, school closures also disrupted routines, which for many people of all ages with mental health problems can be particularly important as a coping mechanism. It has been suggested that being unable to attend school or university in person, or part-time jobs, can lead to a relapse in symptoms where young people relied on these routines. Refusing to undertake typical daily activities such as showering, getting out of bed and eating sufficient meals are some of the effects seen amongst these young people – all which can exacerbate feelings of depression or loneliness.
Role of families
Families have been found to play a vital part in helping young people who are suffering from mental health issues. This has only become more apparent with the impact of COVID-19 lockdowns, where young people would most likely be living with their family – whether that be parents, siblings or other relatives or caregivers. Lockdown guidelines that mandated staying at home would leave these young people spending more time with their families, and the closure of other services outwith the home, meant these young people’s households often became their main support system. The NHS follow-up survey found that both family connectedness and family functioning were associated with mental disorder, highlighting the importance of supporting families to enable them to support young people’s mental health.
The Local Government Association has recently published a guide on a “whole household approach” to young people’s mental health, stressing the importance of educating families on how to support their young people. This is highlighted as particularly important when they transition from child services to adult services as many teenagers and young people struggle with the lack of support offered when they are legally considered adults.
Social media
Another big issue affecting young people’s mental health is the use of social media. While there are many reported benefits of social media, particularly in relation to connecting with others, there are also growing concerns about its effects on wellbeing and the pandemic has undoubtedly exacerbated this. The NHS survey found that, in 2021, half (50.7%) of 11-16 year olds agreed that they spent more time on social media than they meant to and 16.7% using social media agreed that the number of likes, comments and shares they received had an impact on their mood. Those with a probable mental disorder were particularly likely to spend more time on social media than they intended, and girls seem to be more affected that boys.
The survey found that 21.1% of girls reported that likes, comments and shares from social media affected their mood, compared to 12.1% of boys. It also found that double the number of girls than boys spent more time on social media than they meant to. Other research has also highlighted the disproportionate impact on young girls. One study found that constant social media use predicted lower wellbeing in girls only and that these mental health harms may be due to a combination of cyberbullying, and a lack of sleep or exercise. This was not found in the teenage boys interviewed.
Solutions
When addressing mental health problems, it is clear that a ‘one size fits all’ approach does not work. As highlighted in the research, mental health problems can present themselves in a range of ways, and depend on a number of variables. People from different socio-economic and cultural backgrounds, or those with additional needs, often face more stigma and can find it more difficult to express their problems or access the correct support for their specific needs.
There have been suggestions for more targeted support for young people and the issues they may be facing, including more investment in schools and social services. Particularly for adolescents who are transitioning to adulthood, it is important to provide continuous support. As highlighted in the NHS Mental Health Survey, more adolescents and young adults (17 to 23 year olds) mentioned a decrease in their mental health than younger people (6 to 16 year olds). Children and Young People’s Mental Health Services (CYPMHS) notes that the transition from child to adult mental health services tends to begin around three to six months before the individual turns 18, although there can be flexibility. Perhaps even greater flexibility is required, particularly as we assess the damage left by the pandemic. It is argued that engaging adolescents in the provision of mental health services and a shift towards early intervention and prevention will also be important as we look to build new solutions.
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The Coronavirus pandemic (COVID-19) has impacted all sectors of our society, but none more-so than public health services.
Last month, The Health Foundation hosted a webinar discussing the lessons from the pandemic and the future role of public health. The webinar drew on the findings from The Kings Fund report “Directors of public health and the COVID-19 pandemic”. It considered the issues facing public health as a result of COVID-19, and proposed steps to rebuild the healthcare sector and begin tackling the problems left as we slowly move out of the pandemic.
Lack of resources
One of the main themes of the webinar was raised by Shilpa Ross of The Kings Fund, who explained that a lack of resources and shortages in public health existed long before the COVID-19 pandemic. The impact of longer term reductions to the public health grant meant that health services were not ready for the pandemic, nor for how long it has lasted. This has had a knock-on effect elsewhere in the NHS. A Care Quality Commission report noted that in July 2021, almost 300,000 people were waiting more than 52 weeks to begin hospital treatment.
On top of this, public health has faced staff shortages. Because so many healthcare services are “fishing in the same pond for recruits,” Shilpa explained that it has been especially hard to fill vacancies. In addition, many healthcare workers have experienced short and long-term effects of the virus, and the additional workloads have left many stressed and burnt out. The disruption to education could further delay the training and employment of potential new healthcare workers.
While the NHS has in some cases set up drop-in sessions for support and made efforts to provide even basic support, such as bottled water to aid hydration, these cannot fill the hole created by healthcare staff shortages.
Widening inequalities
Professor Kevin Fenton of Public Health England argued that “inequalities have defined the pandemic,” and would be the legacy of the last year and a half. A 2020 report by the Institute of Health Equity, commissioned by The Health Foundation, found that in England members of Black, Asian and minority ethnic groups (BAME) were more likely to be affected by COVID-19. The report attributed this partly to people in these groups living in more deprived areas, working in occupations with a higher exposure risk to the virus (such as healthcare or customer service roles), and in some cases living with multiple generations in their home (complicating self-isolation). The authors contended that while inequalities in social and economic conditions were present before the pandemic, they contributed to the unequal death toll resulting from COVID-19.
These inequalities have widened, partly due to the shortage of resources and staff. It has only grown more difficult to address the ever increasing numbers of people needing treatment, both urgent and non-urgent. As a result, the most vulnerable in society have fallen by the wayside.
Changing how public health works
The webinar also discussed how public health can move forward as the country slowly returns to a new form of normal. In addition to the restructuring of Public Health England, a new tax – the Health and Social Care Levy – will put an additional £12 billion into health and social care over the next three years. However, money alone is not enough – the webinar participants agreed that the infrastructures and inner workings of public health must evolve as we move towards a more efficient system of working.
Professor Fenton stressed the importance of engaging with local communities, and that the response towards the pandemic going forward must be grounded in their experiences, and what they need from both the public health system and also local authorities. He noted that while there may be pressure to go back to the way things operated before the pandemic, we must move forward: by understanding what worked and what didn’t, progress and better services can be achieved. Shilpa Ross added that a more targeted and tailored approach to health inequalities has provided more significant results in terms of vaccination and testing rates. This has in turn raised levels of trust within communities that public health teams may not have engaged with before the pandemic. All of this, however, takes up precious time.
Professor Jim McManus, Director of Public Health for Hertfordshire County Council, highlighted the importance of prevention not only for COVID-19 moving forward but other health conditions. He stated that they must be tackled at a place where they can stop others continuing to be affected, in addition to treating those who are currently being affected. Robin Tuddenham, Accountable Officer for NHS Calderdale Clinical Commissioning Group, agreed, and stressed that problems like homelessness and poverty should not be seen as separate from health but rather as important factors in the prevention of ill health.
Concluding thoughts
Highlighting the underlying issues and difficulties affecting public health before the pandemic is one step towards addressing them.
The webinar demonstrated that the pandemic has shifted how public health is perceived and valued. It has reminded all of us how important access to efficient, well-supported and high quality healthcare really is. Those working in decision-making roles in the healthcare sector are clearly looking towards the next steps for public health and how to give people the highest quality and most efficient care possible. With this in mind, the pandemic may have created a stepping stone towards a better healthcare system.
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Recently published figures show that waiting times for some non-urgent care across the UK have risen dramatically with the pandemic squeezing the already stretched resources of the NHS. Figures from Public Health Scotland, published in June 2021 found that when comparing to pre-pandemic levels, the waiting list size is 30.3% higher than the 12-month average prior to the onset of the pandemic (Mar 19 – Feb 20), while in England figures published in August 2021 showed NHS waiting lists in England reached a “record” 5.45 million people.
In addition to strains on acute NHS care services on the frontline, there are warnings about the additional public health impacts of delays to preventative healthcare measures like screening and routine medical care as well as concerns about a surge in demand when people who have delayed seeking non-urgent diagnosis and treatment return to hospitals.
At the outbreak of the pandemic many hospitals took the decision to delay or stop entirely routine pre-planned surgeries and preventative screening and diagnostics. Some even suspended treatment for more urgent care like cancer treatment on a short-term basis. While many of these services have resumed since the beginning of the pandemic, albeit with a backlog of patients now to be seen, significant strain on the NHS as we come into the winter months because of coronavirus is still anticipated.
In many areas this has led to a backlog of care, both for those patients already in the system awaiting routine surgeries, as well as those who are yet to be diagnosed but would have been through preventative screening programmes run by the NHS.
Delays in healthcare and routine screening
Even before the coronavirus pandemic took hold, many NHS hospital trusts were under criticism because of the significant length of waiting times for people who required routine operations. Doctors across the UK are now warning that these delays could be increased further unless the NHS receives additional support to increase capacity across all areas of care – not just urgent care in the coming months.
It has been suggested that delays in diagnosis and routine treatments could lead to an increased number of hospitalisations further down the line, requiring higher levels of care, longer lengths of stay, and increased hospital readmissions.
And despite the recent announcement of a new arrangement for health and care funding, commentators are quick to stress that the £1.4bn the new funding programme is expected to generate may not be enough to suitable address all of the concerns across health and social care, which they highlight has been chronically underfunded for a significant number of years, even before the pandemic exposed the frailty of parts of the system.
A reluctance to visit hospitals and use primary care services
Research from the Health Foundation found that there had been a significant reduction in the number of GP consultations since the start of the pandemic which has led to concerns about the care of non-covid patients, patients with long term health conditions and also the potential for delayed diagnosis. Primary care consultations also reduced and have remained low consistently since the beginning of lockdown.
Figures have also shown a reduction in the number of referrals, medical tests, new prescriptions and immunisations. While some of these reductions are the result of advice to delay routine referrals to free up capacity for hospitals to deal with the potentially large number of cases of Covid-19, routine referrals have still not recovered to pre-lockdown levels.
These figures, and other contributions from commentators and researchers suggest that government messages to ‘protect the NHS’ may have had the unintended consequence of discouraging people from seeking urgent medical care when it was required for fear of using services unnecessarily or for fear of contracting the virus when attending hospital or primary care settings.
Commentators are now warning that the treatment backlog which has been caused by the coronavirus pandemic, in addition to diagnostic delays and screening programmes, may lead to a future crisis of care or significant delays in care for people waiting to receive more routine treatment.
Delays in care have not only been reported in cases of physical health. There have also been significant delays in referrals for those seeking treatment for a mental health condition, an area of the NHS which was already facing significant delays in referral and transfer of care even before the pandemic. Research suggests that incidence of mental illness during the coronavirus pandemic increased. However, the numbers of people accessing services and being referred for treatment have not increased proportionate to this. People with mental health conditions may have been unable to access appropriate support through primary care pathways, which could potentially impact on their long-term health and care.
Finally, concerns have been raised about the wider social determinants of health such as employment and poverty. Public Health England (PHE) published a monitoring tool which looks at the wider impacts of the Covid-19 pandemic on population health, and it is likely that the knock-on impact of the virus could have far reaching consequences for public health in the future as the health implications of lockdown, lack of social interaction and rising unemployment could be significant.
Where next?
While the NHS delivered some elective treatment during the course of the pandemic, the pressure of caring for large numbers of patients, many of whom were seriously unwell with COVID-19 has led to longer delays for the growing number of patients on waiting lists. Figures also show that access to elective treatment fell further in the most deprived areas of England during 2020. Tackling the backlog, and working towards the “levelling up” agenda to reduce health inequalities, both of which have been significantly exacerbated by the pandemic will be a key component of the work in health and social care over the coming months and years.
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Research has shown that healthy food choices are three times more expensive than unhealthy ones, food bank use is at it highest ever level and the NHS is anticipating significant struggles in long term treatment of people with conditions linked to obesity and unhealthy lifestyles, like cancer, diabetes and heart disease.
A forecast published in a report by the Food Foundation showed that if we continue at our current rate and type of food consumption 22% of children born in 2020 will be overweight or obese by age 5, rising to 46% by the time they reach age 21.
But the impact doesn’t stop there. The food system – agriculture, food production, distribution and retail combined – releases more greenhouse gases than any other sector apart from energy. In the UK, the food system accounts for a fifth of domestic emissions – but that figure rises to around 30% if we factor in the emissions produced by all the food we import.
The food we eat – and the way we produce it – is doing damage to both the environment and our health and the government is now trying to take steps to mitigate the damage, and improve our health and wellbeing in the process through the roll out of a national food strategy.
Fixing a broken system
Figures from the Trussell Trust show that between April 2020 and March 2021, a record 2.5 million emergency food parcels were given to people in crisis. The increasing use of foodbanks shows just how deeply entwined inequality, food and health are, and how important it is for a robust and equitable food strategy to be rolled out.
The Broken Plate 2021 report from the Food foundation provides an overview of the food system in the UK, looking across four main themes:
making healthier options more appealing;
making healthier options more affordable;
making healthier and more sustainable options more available; and
addressing inequalities in food so that everyone can have the chance to live longer, healthier lives.
In July 2021 the UK government published a review into how the food system in the UK works and the interventions that could be brought in to prevent the harms from what we eat and the way we eat. The plan sets out recommendations and a strategy for the future which focuses on food being equitable, accessible, healthier, and sustainable.
The recommendations cover a number of key themes:
escape the “junk food cycle”, including introducing a Salt and Sugar Reformulation Tax;
reduce diet-related inequality, including extending eligibility for free school meals;
make the best use of our land – including guaranteeing agricultural payments to help farmers transition to more sustainable land use; and
create a long term shift in food culture, including the development of a robust system of data collection and reporting to help monitor long term progress.
Inequality exacerbated by unequal access to food
One of the most pressing issues around food is its availability and its ability to exacerbate existing inequalities, particularly among disadvantaged groups. We have already seen that food bank use is high (disproportionately so among lower income groups) and that eating healthier food is more expensive than unhealthy food.
The shelf life of more unhealthy and highly processed food is also often longer, so it is easier to store, and food can be spread out and eaten across multiple days more easily. Processed foods, which are often higher in sugar, salt and trans fats (unhealthy fats) also often require less cooking (both in terms of heat energy required to cook them and knowledge of how to prepare them) which for people with reduced access to kitchens, experience of fuel poverty or limited knowledge of preparing food can be more convenient. Research consistently shows that people who fall into these groups are significantly more likely to come from lower socioeconomic backgrounds and have experience of poverty.
Steps are being taken to try and improve access to healthier food for people living on lower incomes, including free school meals and (with a bit of persuasion from Marcus Rashford) a wider roll out to also offer meals during school holidays. The government also runs a voucher system for new parents to help them get access to fresh food like fruit and vegetables.
As has been made clear in the reports, food systems don’t just impact on us as individuals, they also have a significant impact on the environment. The changing climate is at the forefront of everyone’s mind, including multiple extreme weather events, the publication of an IPCC report on climate change, and the run up to COP26, due to be held in Glasgow. So the way we grow and process our food, and how this negatively impacts our environment is coming under greater scrutiny.
Currently, many practices are having a negative and detrimental impact on our environment across a number of areas including carbon emissions, water pollution, reduction in soil health, loss of biodiversity, land use/deforestation.
And commentators are now emphasising that our food system as well as being healthy and accessible should also be sustainable, with programmes developed to reduce food waste, support community-based agriculture schemes, help farmers to transition to more sustainable ways to farm and use land and stimulate demand for in season, sustainably grown, locally sourced food.
Final Thoughts
Food, and our relationship with it is becoming increasingly important, not only for our own personal health and wellbeing, but also for the health of communities more generally, and the health of our planet.
Sustainable, healthy and equitable food systems help to promote healthier choices and reduce our impact on the planet. And food can also play its part in helping to relieve other pressures on society, like food poverty, inequality and the rising use of food banks. Food on prescription services can help support people to make better choices and reduce the risk of diseases like cancer, heart disease, stroke and obesity.
In short, food is not just vital for life, but also for living well.
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The impact of the coronavirus pandemic over the past 18 months has highlighted the vital role of information and knowledge services in supporting health and social care, public health, and medicine.
Last month’s Annual CILIPS Conference included a presentation about #HealthLibrariansAddValue – a joint advocacy campaign between CILIPS and NHS Education for Scotland (NES) which aims to showcase the skills of health librarians and demonstrate the crucial role of health libraries.
Library and knowledge services in the health sector have faced increased pressures and a multitude of challenges throughout the pandemic as they have continued to develop and deliver vital services and resources to colleagues under unprecedented restrictions and changed working practices. With the demand for trustworthy and reliable health information higher than ever, it is clear that well-resourced, coordinated and accessible knowledge services are essential.
Supporting the frontline
Throughout the pandemic, the work of health librarians has been vital in supporting frontline workers including doctors, nurses, pharmacists, and social workers. Hospital library services have been directly involved in medical decision-making, providing evidence and resources to support patient care and the training of medical staff. As the information needs of the medical workforce have changed through the course of the pandemic, health libraries have had to be fast and flexible to provide time sensitive and urgent information to those on the frontline.
A project undertaken by the NHS Borders Library Service saw the creation of a new outreach service for local GPs, which involved the delivery of targeted current awareness bulletins, resource lists, and Covid-19 research updates, all of which directly informed the provision of primary patient care and helped to keep GPs up to date on emerging knowledge about the coronavirus.
Health Education England’s (HEE) Library and Knowledge team adapted their services to meet changing workplace needs, ensuring 24/7 access to digital knowledge resources, gathering evidence on how to keep staff safe while working, and developing training programmes to support virtual working practices for healthcare staff.
Supporting decision-making across sectors
Health librarians have played a major role in informing the UK’s pandemic response at a national level, aiding public health decision-making and facilitating partnership working across sectors.
Librarians from Public Health Scotland’s (PHS) knowledge services have worked closely with PHS colleagues to coordinate Scotland’s response to the pandemic. Their work included the creation of daily Covid-19 updates for PHS’ guidance teams, distributing the latest and most relevant research on key topics, and adapting these updates in line with PHS’ changing priorities (for example as their focus shifted from virus transmission to vaccine efficacy). Librarians at PHS have also been involved in creating evidence summaries to support specific Covid-19 research projects, such as an investigation into the relationship between Covid-19 and vitamin D. The evidence gathered by knowledge services helped PHS to formulate their response on the issue and make national recommendations relating to vitamin D intake.
On 12 July 2021, PHS launched their Covid-19 research repository, which is managed and maintained by the library team and collects, preserves, and provides access to Scottish Covid-19 research. This project aims to support policymakers, researchers, and the public by bringing together Scotland’s Covid-19 research in one place and making it easily accessible for all who need it. It is also aimed at reducing duplication of effort, which health librarians had recognised as a concern during the pandemic.
Similarly, Public Health England (PHE)’s library aimed to tackle the duplication of effort across England by creating their ‘Finding the evidence: Coronavirus’ page which gathers emerging key research and evidence related to Covid-19 and makes it accessible in one place. Many resources on the site are freely available and include a wide range of resources including training materials, and search and fact checking guidance.
Health libraries have also been informing decision-making across the social care and third sectors, with NES librarians facilitating digital access to research and evidence via the Knowledge Network and Social Services Knowledge Scotland (SSKS), and providing training and webinars to help users make the most of such services. NES librarians have been involved in partnership working with organisations such as the Care Inspectorate, SCVO, and Alliance.
Keeping the public informed
A key challenge for health librarians during the pandemic has been in dealing with the information overload and spread of harmful misinformation around Covid-19.
Library and information professionals have had a key role to play in providing trustworthy information to patients and the public, helping people to make informed choices about their health and wellbeing. As previously mentioned, librarians have helped agencies like PHS to deliver clear, meaningful, and authoritative guidance to the public, as well as making up-to-date and reliable Covid-19 research centralised and widely accessible to the public.
The World Health Organization (WHO) emphasises the importance of health literacy in enabling populations to “play an active role in improving their own health, engage successfully with community action for health, and push governments to meet their responsibilities in addressing health and health equity”. Health librarians have been at the forefront of efforts to promote and improve health literacy during the pandemic.
NES’ knowledge services have been delivering training and webinars to health and social care staff on how to improve people’s health literacy, and health librarians working with HEE have created targeted Covid-19 resources for specific groups such as older people and children and young people.
Final thoughts
Clearly, the work of health librarians has been crucial to the UK’s pandemic response and recovery so far, and advocacy campaigns like #HealthLibrariansAddValue are central to highlighting this important work and demonstrating its impact.
Looking forward, it is clear that innovative and high-quality knowledge services will be essential in a post-pandemic world as they continue to aid recovery, promote health literacy and support the health and social care workforce. As set out in HEE’s Knowledge for Healthcare framework, investment is required at a national and local level to build expertise and support the digital knowledge infrastructure which will be required.
Further reading: more on health from The Knowledge Exchange blog
The health and care landscape has been changed in unprecedented ways over the past year. The coronavirus pandemic has not only highlighted strains within the system and required a response to a public health emergency unlike anything else that has been seen for decades, it has also provided an opportunity to push innovation in areas like digital infrastructure and partnership working, and encouraged decision makers to look at public health as an essential part of policy making in all areas.
The Knowledge Exchange database is full of reports, articles and documents which offer insight into these themes, published by organisations from across the heath and social care landscape. In this blog post, we’re highlighting some recent additions to our collection and some of the big themes being discussed within the sector.
Covid-19, “building back better” and a “health in all policies” approach
In March 2021 think tank IPPR published their report State of health and care: the NHS Long Term Plan after Covid-19. The recommendations form a £12 billion blueprint to ‘build back better’ in health and care and the report calls for an adaptation of the NHS Long Term Plan published in 2019 focusing on cancer, mental health, cardiovascular disease and multimorbidity. The authors believe the Long Term Plan needs to change to ‘build back better’ health and care post-pandemic, in relation to: ensuring a sustainable workforce; resourcing the NHS to deliver transformation; empowering integration; upgrading the digital NHS; funding and reforming social care; and levelling up the nation’s health.
Another report, from the Local Government Association (LGA), published in September 2020, provides specific guidance to local authority councillors on ways to improve the approach to population health and use of public health resources in dealing with the pandemic, highlighting the Health in All Policies (HiAP) approach to addressing health inequalities and improving wellbeing. There are a number of other resources which look at public health approaches to tackling other areas of policy such as youth violence and urban regeneration.
Build back fairer: the Covid-19 Marmot Review: the pandemic, socioeconomic and health inequalities in England, published by the Health Foundation and the Institute of Health Equity examines inequalities in coronavirus mortality, looks at the effects that the pandemic, and the societal response, have had on social and economic inequalities, the effects on mental and physical health, and the likely effects on health inequalities in the future. The report assesses the inequalities in the risk of COVID-19 and mortality and explores the impact of containment on inequalities in the social determinants of health, in terms of: early life; education; children and young people; employment and working conditions; a healthy standard of living; healthy and sustainable places and communities; and healthy behaviours.
Mental health
Mental health services have been under significant pressure in the UK for a number of years now, with children’s services (CAMHS) particularly stretched as the number of specialist practitioners is limited. The coronavirus pandemic has, according to many specialists, exacerbated existing pressures and placed even more demand on services. In April 2021 the All-Party Parliamentary Group on a Fit and Healthy Childhood published a report: The COVID generation: a mental health pandemic in the making – the impact on the mental health of children and young people during and after the COVID-19 pandemicwhich explores a range of themes in relation to the impact of the pandemic on the mental health of children and young people. The report presents evidence from a range of sources on the potential implications of the pandemic on young people’s mental health and discusses the impact of school closures on children’s future health and well-being.
The Children’s Commissioner for England recently published a report which looks at the progress made in improving children’s mental health services in England, and the impact of the pandemic on the mental health of children. The report also examines the provision and accessibility of children’s mental health services in 2019/20, finding that access is still not adequate and not improving as quickly as expected.
The other pandemic: the impact of Covid-19 on Britain’s mental healthexplores how the mental health of people in the UK has been affected by the pandemic, drawing on a survey of over 4000 people. It describes the different experiences of groups across society and the highlights the disproportionate mental health impact on people who are exposed to higher levels of social deprivation, as well as on women, younger people and those who live alone.
In August 2020 the Health Devolution Commission launched its final report, Building back health and prosperity. Among other themes, such as taking a “health in all policies approach”, the report found that devolving accountability and power to a more local level creates the potential to understand communities and places better, and to meet their needs.
One of the main focuses of the health and social care white paper published in February 2021 is around developing an integrated health and social care system and taking a ‘population health’ preventative approach to healthcare, while a report from the NHS confederation recommends a reformation of the framework for elective care and increased healthcare funding.
Digital transformation
Even before the pandemic, The King’s Fund was publishing widely on digital transformation. But their recent report Understanding factors that enabled digital service change in general practice during the Covid-19 pandemic looks specifically at the impact of the pandemic on accelerating the transformation of the delivery of some services by GPs to focus more on digital delivery and whether this change can (or should) be sustained once the pandemic is over. It explores the challenges around trust, staff and patient digital literacy and the evaluation of digital tools in practice. Parliamentary Office of Science and Technology (POST) published their own review of AI and healthcare , providing an overview of AI in the healthcare system and its potential impacts on the cost and quality of healthcare, and on the workforce.
Final thoughts
The landscape of health and care is changing. The Covid-19 pandemic has placed unprecedented demands on a system which was already facing significant challenges. While in some instances this has led to innovation and accelerated the pace of change, it has also exposed some of the significant weaknesses of the system.
This blog highlights some of the big topics the sector is currently grappling with, but there is more available for TKE members on our database. Members can also sign up to receive our health Topic Update, which will provide fortnightly email updates of items recently added to the collection in health, easily allowing you to stay up to date.
If your organisation is not a member of the Knowledge Exchange and you would like more information, please contact us.
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