Social Policy and Practice …. an essential resource for anyone working in public health

We’re proud to be part of the publishing consortium which creates Social Policy and Practice, the only UK-produced social science database focused on social care, social services, public health, social policy and public policy.

So we’re thrilled that during October anyone can get free access to the database via Ovid and Wolters Kluwers’ Health, the internationally-recognised leader in medical information services.

There’s still a few days left of the special offer, so why not test drive it for free!

Addressing priorities in public health

Over the last few years there have been major changes in the public health landscape in the UK. Responsibility for commissioning many public health services moved from the NHS to local authorities, as a result of government reforms.

The King’s Fund has suggested that one challenge of this shift has been bridging the cultures of the NHS and local authorities. In particular there were clear differences in the understanding, value and use of evidence to determine decision-making and policy.

The continuing pressure on local authority budgets has also threatened the focus on prevention and joined up service delivery which is essential for tackling many public health issues.

Recent feedback on Social Policy and Practice has highlighted its strong coverage of many current priority issues in public health, such as:

  • dementia care
  • delayed discharge
  • funding of long term care
  • safeguarding of both children and adults
  • supporting resilience and well-being
  • tackling obesity
  • asset-based approaches

As a UK-produced database you will also find information on topical policy issues such as minimum alcohol pricing, sugar taxes, and the possible impact on the health and social care workforce of Brexit.

A valued resource

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports the ability to take a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.

Social Policy and Practice was also identified by the Alliance for Useful Evidence in a major mapping exercise in 2015, as a key resource supporting evidence use in government and the public sector.

Social Policy and Practice boasts over 400,000 references to papers, books and reports and about 30% of the total content is grey literature, which is hard to find elsewhere.

The focus is on research and evidence that is relevant to those in the UK. A large proportion of material relates to delivery and policy within the UK and the devolved nations of Scotland, Wales and Northern Ireland, but the database also contains resources of interest from Europe and across the world.

To see for yourself why so many UK universities, local authorities and NHS bodies rely on Social Policy and Practice as a resource, visit Ovid Resource of the Month for instant access.

To find out more about the history of the database and the consortium of publishers behind it, read this article from 2016 which we have been given permission to share.

Are controversial ‘fix rooms’ a solution or a problem?

By Steven McGinty

In August, Glasgow City Alcohol and Drug Partnership (ADP) announced that it had found a potential site for its pilot drug consumption facility.

This new service provides drug users with a place to inject drugs under clinical supervision and discard their needles. Other services may also be offered, including the prescription of pharmaceutical grade heroin (administered under strict controls) and the development of a peer support network.

The site in Glasgow’s city centre would be the first in the UK and it’s hoped that it would be up-and-running by 2018. However, these proposals have been met with a mixed response.

Drug consumption rooms

First established in Bern, Switzerland, in 1986, drug consumption rooms were a response to concerns over the spread of HIV/AIDS, increases in drug related deaths, and the rise of public drug deaths in European cities. They were also part of a wider shift in drugs policy, where traditional abstinence-based approaches were being replaced by harm reduction programmes, which focused on reducing the negative impacts of drug abuse.

Since then, over 90 drug consumption facilities have been opened in countries such as Denmark, Germany, the Netherlands, and Canada.

The case for Glasgow

Approximately 500 drug users inject in public places in the city centre. This small group of people accounts for the majority of discarded needles – a major public health risk for the city – and for many instances of public order problems. As a result, Glasgow City Council, Police Scotland and other agencies are spending significant resources managing drug misuse in the city centre.

Although this small group of public injectors provides challenges, they are also vulnerable and often experience other issues such as homelessness, mental health issues, and recent imprisonment. In particular, they are far more likely to suffer health problems. This includes an increased risk of blood-borne viruses, injecting-related serious infections, and overdoses and drug-related deaths. In recent years, the statistics have shown a decline in the health of Glasgow’s drug users. In 2015, the number of HIV infection cases rose from a consistent 10 to 47 per year. Drug-related deaths also rose from 157 to 170 in 2016.

As Susanne Millar, chief officer of Planning, Strategy and Commissioning for the Glasgow City Health and Social Care Partnership, and chair of the ADP, explains:

People injecting drugs in public spaces are experiencing high levels of harm and are impacting on the wider community. We need to make our communities safer for all people living in and visiting the city, including those who publicly inject.”

What the experts say

Many have welcomed the announcement.

Dr Emilia Crighton, director of Public Health at NHS Greater Glasgow and Clyde, and vice chair of the ADP, argues that Glasgow is decades behind other countries in how it responds to drug addiction. She highlights that the city has been at the centre of high profile cases of anthrax, botulism and HIV infection, and that conventional treatment has not been successful at reducing health risks. She explains:

Our ultimate goal is for drug users to recover from their addiction and remain drug free. However, until someone is ready to seek and receive help to stop using drugs it is important to keep them as safe as possible while they do continue to use drugs.”

David Liddell, Chief Executive Officer of the Scottish Drugs Forum, is also in favour of the new facility, explaining that they have been successful in other countries.

They may seem controversial but when you see that these have been running in many countries in Europe for up to 30 years, you get a different perspective. Holland now has 31 drug consumption rooms and Germany has 24, for example. From these years of practice, clear evidence has emerged as to the effectiveness of these facilities.”

But there has also been some notable criticism. For example, Professor Neil McKeganey, an expert in drugs policy with the Centre for Substance Use Research in Glasgow, argued that the scheme is highly flawed. He believes that David Liddell is wrong, and contends that the proposed facilities are controversial. Professor McKeganey highlights previous research with drug addicts in Scotland which found that only 5% wanted to inject more safely, with the overwhelming majority wanting to receive treatment and become drug free. Professor McKeganey also suggests that ‘supposedly’ safer places to inject will not reduce the rising cases of HIV infection and other drug-related harms.

He warns that although these services have a role to play, “there is a real danger here we are moving steadily away from services to get addicts off drugs.

Final thoughts

There is a growing body of research into the effectiveness of drug consumption rooms. The European Monitoring Centre for Drugs and Drug Addiction has found that drug consumption facilities can deliver a number of benefits, including:

  • increasing access to health and social services;
  • supporting safe and hygienic drug use; and
  • reducing public drug use and associated nuisance.

However, the evidence on whether drug consumption rooms reduce cases of HIV or the hepatitis C virus remain unclear. And research has also shown that some countries can find it difficult to establish a legal basis for facilities – as the recent suspension of a facility in Greece demonstrates.

For Glasgow, it probably is about time that a drug consumption room was piloted. However, it will be important that its impacts are fully evaluated and that resources for drug treatment services are maintained in the coming years.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

If you found this article interesting, you may also like to read some of other health-related articles. 

Why a holistic approach to public health and social care needs a wider evidence base … and how Social Policy and Practice can help

SPP screenshot2016 has been described as “make or break time for the NHS”, and with pressures on finances increasing, social care and public health are in the spotlight. Around £1 in every £5 of NHS spending is estimated to be the result of ill health attributable to the big five risk factors of smoking, alcohol, poor diet, obesity and inactivity. Investing in prevention, and understanding the complex wider community and social factors that lead to poor health, is therefore important. In cash-strapped local authorities however, investment in preventative projects can be sidelined in the face of tackling acute issues.

Prevention and behaviour change are linked

Recent health policy has included an expectation that individuals should take greater responsibility for their own health. But where we are talking about behaviour change, there is no quick fix. Glib use of the term ‘nudge’ to promote change can suggest that laziness is the only issue. However, research such as that by the King’s Fund has highlighted that motivation and confidence are essential if people are to successfully modify their health behaviours.

Practitioners within the field of both public health and social care need help understanding what works – but as two great recent blogs from the Alliance for Useful Evidence noted, change can be achieved in multiple ways and evidence shouldn’t be used to prove a service works but as part of a journey of improvement and learning.

We talk about the “caring professions”, but it seems that it can be difficult to maintain a focus on the ‘person not the patient’ when budgets are being cut. Well-reported issues such as the rise in the use of 15-minute home care appointments are just one symptom of this. More generally, making time to consider alternative approaches or learn from good practice elsewhere can be hard. That is where having access to a trusted database can help.

Trusted source of research and ideas

The Alliance for Useful Evidence, most recently in its practice guide to using research evidence, has highlighted the importance of using trusted sources rather than “haphazard online searches”. One of these resources is Social Policy and Practice, a database which we have contributed to for twelve years.

“SPP is useful for any professional working in the field of social care or social work who can’t get easy access to a university library.” Alliance for Useful Evidence, 2016

The partners who contribute to the database – Centre for Policy on Ageing, Idox Information Service, National Children’s Bureau, the NSPCC and the Social Care Institute for Excellence – are all committed to sharing their focused collections with the wider world of researchers and to influence policy and practice.

Social Policy and Practice is the UK’s only national social science database embracing social care, social policy, social services, and public policy. It boasts over 400,000 references to papers, books and reports and about 30% of the total content is grey literature.

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports the ability to take a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.

Find out more about the development of the Social Policy and Practice database in this article from CILIP Update. Update is the leading publication for the library, information and knowledge management community and they’ve given us permission to share this article.

If you are interested in using the Social Policy and Practice (SPP) database for evidence and research in health and social care, please visit for more information and to request a free trial.

Read some of our other blogs on evidence use in public policy:

The Dickensian disease: TB in 21st century England

England has the second highest tuberculosis (TB) rate in Western Europe, and a rate that is more than four times as high as in the US. Why is this seemingly Dickensian disease making a comeback in England today? And what is being done to tackle it?

The TB capital of Western Europe

Figures show that TB cases are centred on large urban centres; Manchester, Birmingham and Coventry to name just three. However London accounts for almost 50% of all cases of TB reported in England. A third of London boroughs are classed as ‘high incidence’ by the World Health Organisation (WHO), placing them in the same band as countries like Iraq and Rwanda, with more than 40 confirmed cases per 100,000 people per day.

In 2013 there were 3,500 new cases of TB diagnosed in the capital. Healthcare professionals stress the importance of early diagnosis and treatment as being a key strategy to eradicating the disease.

Stigmatisation is a real issue

TB is strongly associated with poverty and research has suggested that many people do not seek treatment for the disease because they are embarrassed about the potential repercussions of having to tell family members, support workers or employers. This not only poses a risk to the infected person, but significantly increases the chances of passing the infection on to others.

Similarly, statistics show that cases of TB are particularly prevalent among homeless populations and other vulnerable minority groups. Delays in seeking treatment, already-reduced immunity, pre-existing strains of the disease which can reoccur, and overcrowded shelters can all contribute to spreading the disease, which is caught through prolonged contact with an infected person (the bacteria is spread through airborne droplets).

Another barrier to effective treatment is misdiagnosis by general practitioners.  As a result there has been a conscious effort in London in particular to educate general practitioners and other primary healthcare workers on possible symptoms in the hope that it will help increase rates of diagnosis and treatment, and reduce the number of new cases.

A public health emergency?

However, the rise of antibiotic and drug resistant strains of the disease is making treatment of TB even more difficult. A full course of treatment of non-drug resistant TB bacteria can take up to two years in some cases. If the strain is drug resistant, patients can be taking as many as 9 different drugs a day, many of which have severe side effects and can be life-limiting in themselves.

Doctors have suggested that the rise of these drug resistant strains is not being taken seriously by Public Health England, or other associated bodies and that drug resistant TB should be considered as a public health emergency. In 2014 the LGA produced guidance on the public health role which should be taken on by local authorities to tackle TB locally within communities.

Updated guidance and treatment programmes

In early 2016, the National Institute for Health and Care Excellence (NICE) published updated guidance on TB, with a particularly strong focus on: early treatment; targeting vulnerable groups; and improving education and awareness of the disease for patients and GPs on how to spot symptoms.

Prior to this, in 2015, Public Health England produced a collaborative strategy, in partnership with NHS England, to tackle TB in England. The strategy looks at how health boards, local authorities and national bodies can cooperate to achieve national outcomes on TB diagnosis, treatment and eventual eradication. The report considers the creation of nine regional TB control boards, who would work alongside national bodies to achieve these national objectives. London-specific objectives and strategies were published in October 2015.

Practical support for sufferers in communities

Find & Treat  provides screening, advice and practical assistance to TB services and allied health and social care services in London. In partnership with Groundswell (a charity supporting homeless people), the team behind Find & Treat also recruit, train and support former TB patients who have experienced homelessness to work as peer advocates in their TB awareness team.

The Mobile X-ray Unit (MXU) now screens almost 10,000 socially vulnerable people at high risk of TB annually. The screening service operates in every London borough, and is regularly called to support the control of TB outbreaks nationally. University College London Hospitals (UCLH) host the service on behalf of NHS London, and are close to rolling out the Find & Treat initiative nationally (as recommended by NICE). Additionally in London there are two designated ‘hub’ hospitals, in the north and the south of the city with designated teams of TB specialists.

To further increase the profile of TB, prevention and treatment, actress Emma Thompson has been appointed as the Mayor of London’s TB Ambassador. This follows her son’s diagnosis with TB in 2011. Since her appointment she has been a very public face of TB awareness, regularly attending clinics and health drives to encourage people to get tested for the disease.

As the statistics have shown, TB rates are frighteningly high in some areas of the UK, and particularly in London. It is hoped that increased guidance and public awareness will help stop the increase of cases and avoid the potential public health epidemic which could arise in London as the population grows and pressure on NHS services intensifies. There is added incentive to curb this spread as the rise of antibiotic resistant strains becomes more prevalent.

Vaccination programmes, effective treatment centres and early intervention community initiatives, as well as investment in research and development for new drugs to treat the disease effectively, will be key to ensuring positive outcomes for all those affected by, or at risk of, TB in the UK.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Further blog posts from The Knowledge Exchange on health:

Health Champions – “unlocking the power of communities”

Health Cubes_iStock_000022075266Large

By Heather Cameron

“On the societal level, we must understand that health is not an individual outcome, but arises from social cohesion, community ties, and mutual support.” Dr Gabor Maté

Health inequalities have long been an issue in the UK and despite continuous government commitment to tackling them, they continue to persist.

It is estimated that avoidable illness costs around £60 billion and that 1 in 4 deaths are preventable with the adoption of healthier lifestyles. Calls have therefore been made for radical changes in the approach to public health by improving health and wellbeing outside of the core public health workforce.

This is just the approach of the Community Health Champion model, developed by Altogether Better, which has demonstrated not only the positive impact on health but the social value of such an approach.

What are health champions?

Health Champions are volunteers from all walks of life who are provided with accredited training and support so they can undertake health promotion activities within their communities to reduce health inequalities and improve the health of the local population.

The Community Health Champion role began as a five year Big Lottery Funded programme (Wellbeing 1) in 2008. Over 18,000 Health Champions were recruited, trained and supported between 2008 and 2012, reaching over 105,000 people.

Through a combination of their training and own personal experiences, these volunteers empower and encourage people within their families, communities and workplaces to take up healthy activities, create groups to meet local needs and can signpost people to relevant support and services.


While Wellbeing 1 succeeded in reaching many people in need, the programme also raised two specific challenges: in almost all cases, the work being done was invisible to the NHS; and securing ongoing funding to continue the support was difficult.

Peer support was later identified as the most appropriate way of trying to connect communities with health services.

Following this recognition and the success of the original model, further lottery funding was awarded to develop the Champion model and use it to engage champions, communities and health services (Wellbeing 2).

Co-production of health and wellbeing outcomes

The model was applied to health services specifically with the aim of addressing the apparent disconnect between the NHS and community-based services. It helps connect both patients with support in their communities and professional practices with those communities.

Many citizens have volunteered in different ways and in different settings. These include:

  • Practice Health Champions working closely with their General Practice to create new ways for patients to access non-clinical support
  • Youth Health Champions where children and young people are recruited, trained and supported to help young people more actively engage with and influence their own and their community’s health
  • Pregnancy and early years Health Champions who are interested in giving children a better start
  • Health Champions working within a specialist, hospital-based NHS service
  • Senior Health Champions who engage with older people, offering a complimentary approach to more formal programmes

Community-based health improvement initiatives such as this could help to strengthen community-professional partnerships and cross-collaboration among health, social and other services. And this in turn could lead to a reduction in health inequalities.

Positive outcomes

According to a recent evaluation of the Health Champions programme, Wellbeing 2 has resulted in a range of benefits:

  • 86% of champions and 94% of participants in the programme reported increased levels of confidence and well-being;
  • 87% of champions and 94% of participants in the programme acquired significant new knowledge related to health and well-being;
  • 98% of champions and 99% of participants in the programme reported increased involvement in social activities and social groups;
  • 95% of practice staff involved with the programme would recommend it and wish to continue.

Other benefits included reduced social isolation, increased levels of exercise/healthy eating and feeling physically better. One champion reported “this has helped me more than any medication might.”

Success stories  include the work of a cycle champion who has improved her own health and wellbeing, encouraged over 70 other people to improve theirs through taking up cycling, provided cycle training to over 50 people in 6 community groups and provided specific detailed help to 5 people.

Other successes have involved volunteers setting up football training, providing support to women with mental health issues, providing advice and support to ethnic minorities and providing advice on healthy eating.

In terms of monetary value, an  analysis of the social return on investment (SROI) of a series of Altogether Better project beneficiaries found a positive SROI of between £0.79 and £112.42 for every pound invested, highlighting the potential value of these initiatives to funders.

Final thoughts

At a time of increasing demands on health services and with the relentless squeeze on public sector resources, perhaps the move towards greater community empowerment and collaboration across sectors is the right one. After all, as I’m sure we’d all agree, prevention is better than cure.

If you liked this blog post, you might also want to read Heather’s earlier post on social prescribing

Follow us on Twitter to see what developments in policy and practice are interesting our research team.



Should the UK introduce a tax on sugar?

An assortment of liquorice allsorts sweets.

by Stacey Dingwall

Recent months have seen two enquiries to our Ask a Researcher service for evidence on sugar consumption in the UK. Namely: should this be taxed?

Sugar has become somewhat of a villain in the UK, with magazine articles, research and governments all telling us that we should be greatly reducing, or even eradicating completely, our consumption of added sugars in particular. The week beginning 30th of November even saw the first National Sugar Awareness Week, part of a campaign to encourage the government to establish a sugar reduction programme in the UK. However, is a ‘sugar tax’ really necessary?

Sugar consumption: a public health issue?

According to the Royal Society for Public Health (RSPH), absolutely. Last month, they published a review of how to tackle obesity in the UK, which included the introduction of a sugar tax. The report notes that, according to the latest forecasts, half of all adults in the UK are expected to be classed as obese by 2050. Key to reversing this trend, it is argued, is to tackle issues around diet and nutrition among children, who are now spending double the amount of time per day in front of screens than children in 1995 (something that has been shown to increase cravings for food and drink, but not for nutritionally sound items). Alongside other developed nations, the UK is also seeing an ever increasing rate of consumption of high-sugar carbonated drinks.

While the RSPH recommends placing restrictions, or ending, the use of advertising and sponsorship by junk food and drinks companies around family and sporting events, it also argues that this is not enough to tackle the country’s obesity problem. The RSPH supports the introduction of a tax on sugary drinks of 20%, or 20p per litre. Their report highlights evidence which suggests that this could prevent or delay around 200,000 cases of obesity per year, and points to the experience of Mexico, who introduced a tax of 10% at the start of 2014. During that year, sales of sugary drinks declined by 6% overall, and by 9% among those living in the most deprived areas of the country (the demographic group most likely to be obese).

What does the government think?

After a delay, the UK government published Public Health England’s (PHE) review of the evidence for action with regards to sugar reduction in October. The report:

  • agrees that too much sugar is consumed in the UK
  • favours a reduction in advertising to children
  • recommends the introduction of a tax on full sugar soft drinks of 10-20%

This, combined with a range of other measures, it is argued, could save the NHS £500 million per year. The PHE recommendation was also supported by the House of Commons Health Committee, in their recently published Childhood obesity – brave and bold action report. Having heard evidence from parties including Sustain and Jamie Oliver, a key figure in the campaign for the introduction of a sugar tax, the Committee recommended that such a levy should be introduced at 20%, in order to achieve maximum impact.

The Prime Minister, however, is still not convinced, stating that he believes there are “more effective” ways of tackling obesity. The government is due to publish a strategy on childhood obesity in the New Year.

What does the evidence say?

A number of countries have implemented a form of taxation on sugar or saturated fats. These include:

  • a tax on saturated fats in Denmark
  • Finland’s tax on sweets, ice cream and soft drinks
  • Hungary’s public health product tax
  • France’s tax on sugar- and artificially-sweetened beverages

According to a review of using price policies such as these to promote healthier diets by the World Health Organization, food pricing policies are feasible, and can influence consumption and purchasing patterns as intended, with a significant impact on important dietary and health-related behaviour. Crucially, however, the same review notes a lack of formal evaluation in this area.

A report published earlier this year by the activist group Taxpayers’ Union of New Zealand, Fizzed out: why a sugar tax won’t curb obesity,  questioned the validity of nutrition related taxes. Reviewing the experience of Mexico, they suggested that the reduction in consumption of sugary drinks following the introduction of an excise tax of one peso per litre in January 2014 had been overplayed.

It’s also the case that the Danish tax on saturated fats was repealed by the government after only one year. This was due to a number of economic impacts that quickly became apparent after the tax was implemented, and resulted in plans for similar taxes to be abandoned. In fact, fat consumption in Denmark has been on a downward trend for some time now, therefore no tax incentive was required. And according to the Danish minister of finance, “to tax food for public health reasons [is] misguided at best and may be counter‐productive at worst”.

Whether the UK Prime Minister will be swayed on this matter remains to be seen. It’s likely that a ‘sugar tax’ will continue to be deemed too politically sensitive to introduce, especially as one in five people continue to live below the poverty line.

Related reading
Child obesity: public health or child protection issue?

Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

Increasing participation in sport and physical activity

by Stacey Dingwall

Our latest member briefing focuses on increasing participation in sport and physical activity in the UK, looking at successful examples of increasing activity and ways in which policymakers are trying to overcome the barriers to participation in sport and physical exercise. You can download the briefing for free from the Knowledge Exchange publications page.

Physical activity levels in the UK

Despite the longstanding and valued position in British society of sport, getting people of all ages involved in sport and physical activity has become increasingly challenging. While current UK guidelines for aerobic activity recommend that adults aged 19 and over should spend at least 150 minutes per week in moderately intensive physical activity, the latest statistics on physical activity from the British Heart Foundation indicate that:

  • Only 67% of men in England and Scotland report meeting recommended levels of physical activity, and only 59% in Northern Ireland and 37% in Wales;
  • Women are less active than men in all UK countries, with 58% reporting meeting recommended levels in Scotland, 55% in England, and 49% in Northern Ireland and 23% in Wales;
  • Physical activity levels vary by household income; in England in 2012, 76% of men in the highest income quintile reached recommended levels, compared to 55% of men in the lowest income quintile.

The implications of inactivity

Low levels of physical activity not only have health implications, but also economic – in the UK, inactivity has been estimated to cost the NHS £1.1billion (Allender, 2007) with indirect costs to society bringing this cost to a total of £8.2billion.

Government action

Our briefing highlights the range of policies and interventions implemented by the UK and devolved governments to try and increase participation in sport and physical activity among the population. These include the Department of Education’s £150m per year Primary PE and Sport Premium Fund; and Scotland’s sport strategy for children and young people, Giving Children and Young People a Sporting Chance.

Good practice – home and abroad

In addition, the briefing profiles successful interventions at the community level, such as Let’s Get Fizzical, a physical activity programme for young people delivered by StreetGames in collaboration with Birmingham City Council. International examples of good practice are also highlighted, including the Active Healthy Kids Canada programme and the North Karelia Project in Finland.


The Knowledge Exchange specialises in public and social policy. To get a flavour of the commentary it offers, please explore our publications page on the Knowledge Exchange website.

To find out more on how to become a member, contact us.

Public health in Scotland … problems and solutions

scotpho logoBy Stacey Dingwall

On Friday 11 September 2015 I attended the annual seminar of the Public Health Information Network for Scotland (PHINS) at Glasgow Royal Concert Hall. Now in its 16th year, the event provides an opportunity to keep up to date with the latest developments in public health related issues and research at both the local and national level.

This year’s sessions were focused around two themes: health inequalities in Scotland, and active travel.

Health inequalities in Scotland: causes and interventions

The first speaker of the day was David Walsh of the Glasgow Centre for Population Health (GCPH). David outlined the findings of research he’s been involved in, looking at explanations for excess mortality in Scotland compared to the rest of the UK and Europe, and in Glasgow particularly. Currently, there are still 5,000 ‘extra’ deaths in Scotland than in England each year, i.e. excess mortality.

The session particularly focused on the findings of the 2013 study, Exploring potential reasons for Glasgow’s ‘excess’ mortality: results of a three-city survey of Glasgow, Liverpool and Manchester. These three cities are home to the highest levels of deprivation in the UK and consequently, the lowest life expectancies, with Glasgow being the worst of the three. David explained that over 40 potential causes for this were synthesised as part of the research, with the following identified as among the most plausible explanations:

  • The scale of urban change post World War 2 had a larger impact on Glasgow, in the form of slum clearances, the construction of poorer housing and large amounts of high rise flats, and limited investment in maintenance of this housing.
  • The ‘socially selective’ new towns programme created social divisions, with only the wealthier and higher-skilled able to move there.
  • Different responses at the local political level – Manchester and especially Liverpool vehemently resisted the Conservative policies of the time, however this was not the case in Glasgow.

The morning also saw a presentation from Jim McCormick from the Joseph Rowntree Foundation (JRF) on rising poverty levels in Scotland and the UK since the recession. Jim suggested that the increasing casual nature of work now seen in the UK is what is driving the rise of poverty. He highlighted the hourglass shaped economy we now have, due to the disappearance of mid-level semi-skilled jobs alongside a rise in higher- and lower-skilled jobs.

An analysis of whether a National Living Wage would bring different groups up to the JRF’s annual Minimum Income Standard by 2020 was also presented; according to their findings, the only group that will be close to it is single people without children.

Physical activity and active travel in Scotland and the UK

The first session after the break saw another presentation from GCPH – this time from Bruce Whyte on trends and challenges in active travel in Scotland (i.e. walking and cycling).

It was highlighted that travelling by car remains the most popular mode for people to travel to work, despite the fact that most of the journeys undertaken are short (i.e. less than two miles long). Bruce highlighted successful initiatives in this area in Glasgow, however, including the cycle hire scheme and the development of the Kelvingrove-Anderston cycling and walking route, on which GCPH published a report earlier this year. His presentation included comment from those who use the route on its health and safety benefits, and it was suggested that its success has led to impetus for similar projects in the city.

The following presentation came from Niamh Shortt of the Centre for Research on Environment, Society and Health (CRESH) at the University of Edinburgh. She looked at the findings from research into whether the physical environment has an impact on inequalities in physical activity and active travel. Tying in with the first theme of the day, this session noted the impact of health and income inequalities on physical activity rates and travel mode choices.

The morning was rounded off by Stuart Hay of Living Streets Scotland, a charity working to promote the benefits of walking and ensure that the country’s streets are fit to do so. Stuart praised the work of the Scottish Government in this area, highlighting the development of a separate walking strategy for the country. He concluded that we have the policy infrastructure in place, and it’s now time to ensure it is implemented.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Read our other recent articles on public health issues:

The Idox Information Service can give you access to a wealth of further information on health inequalities and active travel, to find out more on how to become a member, contact us.

The Licensing Act ten years on: ‘ruinous excess’ or a more civilised drinking culture?

By Heather Cameron

‘Unbridled hedonism is precisely what [the Licensing Act] is about to unleash with all the ghastly consequences that will follow.’

This was what the Daily Mail declared in 2005 in anticipation of the relaxation of the licensing laws. Ten years on, a report by the Institute of Economic Affairs (IEA) claims that this relaxation of the laws did not have the ruinous results predicted by many at the time. On the contrary, the report’s findings suggest that the Act has actually benefited consumers and that violent crimes and other alcohol-related problems have declined.

What changed a decade ago

Introduced in 2005, the Licensing Act abolished set licensing hours in an attempt to make the system more flexible and reduce problems of drinking and disorder associated with a standard closing time, effectively allowing for ‘24-hour drinking’.

Opening hours of premises are now set locally through the conditions of individual licences. The Act gave licensing authorities new powers over licensed premises, whilst giving local people a greater say in individual licensing decisions. The aspiration was that in the longer term its provisions, together with other government initiatives, would help to create a more benign drinking culture.

Many, however, believed these reforms would lead to increased alcohol consumption, more binge-drinking, a worsening of alcohol-fuelled violence and crime, and more alcohol-related attendances to hospital A&E departments.

What actually happened

The IEA’s findings show these fears were unfounded. Key findings of the report include:

  • Alcohol consumption – the consumption of alcohol has fallen by 17% since 2005, the greatest reduction in UK drinking rates since the 1930s.
  • Binge-drinking – rates of binge-drinking have declined for every age group since 2005, with the biggest fall among 16 to 24 year olds (from 29% to 18%). Rates of teetotalism are now as high amongst 16 to 24 year olds as they are amongst pensioners.
  • Violent crime – violent crime fell in the first year following the Act and has declined in most years since. The rate of violent crime has fallen by 40% since 2004/05, incidents of crimes largely aggravated by alcohol have dropped sharply and domestic violence has declined by 28%. Although some evidence suggests that there has been a rise in violent crime between 3am and 6am, this has been offset by a larger decline at the old closing times.
  • Health outcomes – the evidence from A&E departments suggests that there was either no change or a slight decline in alcohol-related admissions after the Act was introduced. Alcohol-related hospital admissions have continued to rise, although at a slower pace than before the Act’s introduction, and there has been no rise in the rate of alcohol-related mortality. There was also a statistically significant decline in late-night traffic accidents following the Act’s enactment.

It would therefore appear that the greater flexibility afforded by the Act which has allowed for increased availability of alcohol has not coincided with a surge in intemperance as predicted.

Rather, by providing greater choice, perhaps the Act has empowered the adult population to act more responsibly. At a time when working hours and patterns vary dramatically by occupation, traditional standard opening times do not accommodate much of the population. In addition, they also do not meet the needs of the growing night-time economy, which is of considerable value to the economy overall, as highlighted in our recent blog.

Other initiatives

It is doubtful, however, that the changes to the licensing laws are the only factor effecting changes in drinking culture. The Act also encouraged other initiatives that have helped to bring about more positive outcomes.

In response to the Act, the Civic Trust’s report Night vision: town centres for all, prompted a number of innovations including a new Civic Trust NightVision design award, a series of practical pilot projects and ideas. This ultimately led to the Purple Flag accreditation scheme, a voluntary scheme to raise the standard of night-time town and city centres, providing accreditation to those places that are managing their night time experience well.

Various other initiatives include: Best Bar None, Pubwatch and Community Alcohol Partnerships. Since Doncaster introduced the Best Bar None scheme in 2006, violent crime has fallen by over 40% in the town centre in the evening.

It would be fair to say that the provisions of the Act and the way they have interacted with other initiatives appear to have had a positive result and not ‘the ghastly consequences’ previously predicted.

As Christopher Snowdon, author of the IEA report, commented:

“The doom-mongers were wrong…The biggest consequence of relaxing licensing laws has been that the public are now better able to enjoy a drink at the time and location of their choice.”

Local authorities have responsibility for over 50 licensing and registration functions. Idox is a market-leading provider of licensing and regulatory services solutions which offer councils an efficient way for monitoring and enforcement.

By streamlining business processes and workflow, the solutions also allow for effective shared services and stakeholder engagement via the online digital service, Public Access for Licensing. 

The Idox Information Service can give you access to a wealth of further information on health and social issues – to find out more on how to become a member, contact us.

Further reading

Crime reduction through regulations (violent disorder and licensed trade), IN Scottish Justice Matters, Vol 3 No 2 Jun 2015

Understanding the alcohol harm paradox in order to focus the development of interventions (2015, Alcohol Research UK)

Regional alcohol consumption and alcohol-related mortality in Great Britain: novel insights using retail sales data, IN BMC Public Health, Vol 15 No 1 2015, pp1-9

Reducing the strength: guidance for councils considering setting up a scheme (tackling street drinking) (2015) Local Government Association

Alcohol interventions, alcohol policy and intimate partner violence: a systematic review, IN BMC Public Health, Vol 14 No 881 2014

Coming up for air: tackling the toxic pollution in our cities


Photograph: James Carson

By James Carson

As we’ve previously reported, air pollution is an invisible killer, estimated to cause 400,000 deaths in Europe – that’s ten times the number of people killed in traffic accidents. In towns and cities, particulate matter and nitrogen dioxide (NO2) from vehicle exhausts are particularly associated with serious health risks, sometimes prompting cities such as Paris to take drastic action.

Since 2010, 16 zones across the UK have failed to meet EU standards on NO2 in the air, prompting a legal challenge by a group of environmental lawyers. At the end of April, the UK supreme court ruled in the group’s favour, and ordered the government to formulate new plans for cutting air pollution by the end of 2015.

As if to remind us of the ongoing presence of air pollution, earlier this year a warm spell of weather pushed smog alert levels in parts of England to “very high” – the most extreme warning that the government’s air pollution monitoring authorities can give.

The British Lung Foundation advised people feeling the effects of the smog in the South East, Greater London, Yorkshire and Humberside and the West Midlands to avoid busy roads during the rush hour, while people with pre-existing conditions, such as asthma, were advised to avoid strenuous activity.

In London, a long-term strategy to address the problem of air pollution from vehicles has recently been announced. The world’s first Ultra Low Emission Zone (ULEZ) will be launched in September 2020, requiring vehicles in central London to meet new emission standards, or pay a daily charge. The ULEZ is expected to halve emissions of nitrogen dioxide and particulate matter, and it’s hoped the move will also give a boost to the green economy by stimulating the development of ultra low emission technology and vehicles.

London already has a low emission zone (LEZ), which was introduced in 2008, and the ULEZ will bring in more stringent emissions standards. However, few other UK cities have followed London’s lead. Last December, the House of Commons Environmental Audit Committee (EAC) called for a national framework for LEZs in the UK, similar to that in Germany, where there are more than 70 LEZs.

Noting that 29,000 deaths each year are attributed to air pollution in the UK, Joan Walley, chairwoman of the EAC, highlighted the potential benefits of the proposal:

“A national framework for low-emission zones could save councils from having to reinvent the wheel each time by providing a template with common core features, such as a national certification scheme for vehicle emissions.”

While London is taking steps towards air quality improvement, other European cities have already progressed well beyond the European Union’s limit values on emissions. Judges assessing the efforts of 23 major European cities to improve air quality placed Zurich in first place due to a policy mix which includes a strong commitment to reduce pollution from vehicles. Other cities achieving high rankings included Copenhagen, Vienna and Stockholm. London also made it into the top ten. At the other end of the scale, Lisbon and Luxembourg finished in the last two places for their “half-hearted” approach to tackling air pollution.

Glasgow, the only other UK city included in the survey, received a disappointing ranking – fifth from the bottom. The survey reported that, even though annual mean levels of NO2 fell, the city did not manage to comply with European limit values. And although Glasgow City Council planned a trial LEZ during the 2014 Commonwealth Games, the implementation was postponed, pending a new Scottish Low Emission Strategy.

The implications of the supreme court ruling are likely to be far-reaching. Diesel cars and trucks could be phased out, and more councils may have to consider congestion pricing, or differentiated parking fees. On the day of the supreme court ruling the campaigners behind the legal challenge restated their belief that all political parties should commit to policies which will deliver clean air and protect public health:

“Air pollution kills tens of thousands of people in this country every year. We brought our case because we have a right to breathe clean air and today the supreme court has upheld that right.”


The Idox Information Service can give you access to a wealth of further information on environmental issues – to find out more on how to become a member, contact us.

Further reading*

Anything but an open road (reducing traffic-borne air pollution)

Action on air quality: sixth report of session 2014-15 (HC 212)

NOx and the city (air pollution in the UK)

Invisible killer (air pollution)

Transport emissions roadmap: cleaner transport for a cleaner London

*Some resources may only be available to members of the Idox Information Service