[The departmental council, a key player in prevention in the region]. / Le conseil départemental, un acteur clé de la prévention sur le territoire.

The decentralization laws of 1982, known as the Defferre law, created the local civil service, giving local authorities powers in areas such as social action and healthcare. The department of Seine-Saint-Denis is a mixed territory with worrying health and social characteristics. To meet these challenges, the Seine-Saint-Denis departmental council has adopted a strong prevention policy. As part of multi-disciplinary teams, state-qualified nurses play a central role in implementing these various preventive missions.

Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England.

BACKGROUND: Commercial advertising and sponsorship drive the consumption of harmful commodities. Local authorities (LAs) have considerable powers to reduce such exposures. This study aimed to characterize local commercial policies across all English LAs. METHODS: We conducted a census of all English LAs (n = 333) to identify local commercial policies concerning advertising and sponsorship of tobacco, alcohol, less healthy foods and gambling, through online searches and Freedom of Information requests. We explored policy presence, commodity frequency and type, and associations with LA characteristics (region, urban/rural and deprivation). RESULTS: Only a third (106) of LAs in England had a relevant policy (32%). These included restrictions on tobacco (91%), gambling (79%), alcohol (74%) and/or less healthy foods (24%). Policy prevalence was lowest in the East of England (22%), North East (25%) and North West (27%), higher in urban areas (36%) than rural areas (28%) and lower in the least (27%) compared with the most (38%) deprived areas. Definitions in policies varied, particularly for alcohol and less healthy foods. CONCLUSIONS: English LAs currently underutilize their levers to reduce the negative impacts of harmful commodity industry marketing, particularly concerning less healthy foods. Standardized guidance, including clarity on definitions and application, could inform local policy development.

A content review of state tobacco pre-emption laws in the US.

OBJECTIVES: State ceiling pre-emption laws effectively limit the authority of local governments to regulate numerous public health issues, including tobacco. While general trends in the number of state tobacco pre-emption laws have been well-documented, less is known about the specific content of these laws. This study provides a comprehensive analysis of the content of current state tobacco pre-emption laws and captures the salient features of these laws. STUDY DESIGN: This was a comparative analysis of tobacco pre-emption laws in the United States. METHODS: The study team collected data about tobacco pre-emption laws from the Centers for Disease Control and Prevention's State Tobacco Activities Tracking and Evaluation System. Trained legal researchers further verified and reviewed each law's content using the Westlaw database. A coding scheme was developed to capture and analyse these laws' most salient features. RESULTS: State tobacco pre-emption laws use various terms to indicate the pre-emption of a local authority, including supersede, pre-empt, uniform, exclusive, and consistent. State laws cover numerous general topics and vary widely in explicit terminology of authorities and fields pre-empted. Several state laws included grandfathering exceptions and a few allowed exceptions for particular local jurisdictions. CONCLUSIONS: State laws that undermine local tobacco control efforts from implementing more stringent laws pose a threat to public health. These laws vary widely in their scope across the U.S., and local jurisdictions should be empowered to enact and maintain tobacco control measures that protect their communities from the harms of tobacco use and exposure.

Supporting and enabling health research in a local authority (SERLA): an exploratory study.

BACKGROUND: The use of research evidence to underpin public health practice and policy decisions in local government is strongly promoted but its implementation has not been straightforward. This study aimed to explore the factors, relationships and processes that contribute towards accessing, using, and generating research evidence that is relevant to local authority public health and social care and shapes its practice. METHODS: Semi-structured individual interviews with elected councillors, officers directly involved with public health and social care and with community members from one urban unitary authority in South England were conducted. Interviews were audio recorded, transcribed verbatim and thematically analysed. RESULTS: Fourteen participants took part in the semi-structured interviews. Local knowledge and evidence are prioritised, and anecdotal evidence is valued. The Director of Public Health was the principal source of information and support. Academics were rarely mentioned as information sources, and their involvement was ad hoc. The use of research evidence varied between individuals and departments, with wider engagement among public health specialists. Key barriers to the use of research evidence included access (not reported among public health professionals), research timeliness, local applicability, competence in finding and interpreting evidence and the role of research evidence within a political context. Public health and adult social care teams are not currently research active or research ready. Major barriers exist due to financial constraints and the socio-political context of local authorities. COVID-19 disrupted siloed ways of working, strengthening and opening potential collaborations within the local authority. This changed perspectives about the value of research but is likely time-limited unless underpinned by sustainable funding. CONCLUSION: Creating strategic level roles within local government to work with the Director of Public Health to champion the research agenda and embedding researchers within and across teams would build capacity for local authorities to sustainably co-create, undertake, and use evidence to better inform future actions.

Who is accessing community lateral flow device testing and why? Characteristics and motivations of individuals participating in COVID-19 community testing in two English local authority areas.

BACKGROUND: Antigen testing using lateral flow devices (LFDs) plays an important role in the management of the novel coronavirus pandemic of 2019 (COVID-19) by rapidly identifying individuals who are asymptomatically carrying high levels of the virus. By January 2021, LFD community testing sites were set up across English local authority areas to support the management and containment of regional COVID-19 cases, initially targeting essential workers unable to work from home during the national lockdown. This study aimed to examine the characteristics and motivations of individuals accessing community LFD testing across two local authority areas (LAAs) in the South West of England. METHODS: Data were collected as part of a service evaluation from December 22nd 2020 until March 15th 2021 for two LAAs. Demographic and postcode data were collected from an online test appointment booking platform and the National Health Service testing service online system, with data accessed from Public Health England. An online survey was sent to individuals who made a testing appointment at an LAA1 site using the online booking platform, consisting of 12 questions to collect data on individual's motivations for and experiences of testing. RESULTS: Data were available for individuals who completed 12,516 tests in LAA1 and 12,327 tests in LAA2. Most individuals who engaged with testing were female, working age, white, and worked as early years or education staff, health and social care staff, and supermarket or food production staff. 1249 individuals completed the survey with 60% of respondents reported getting tested for work-related reasons. Individuals first heard about LFD testing through various channels including work, media, and word of mouth, and decided to get tested based on the ease and convenience of testing, workplace communications, and to identify asymptomatic cases to help stop the spread. Most tests were completed by individuals living in less deprived areas based on national deciles of deprivation. CONCLUSIONS: While national and local COVID-19 testing strategies have evolved, community and personal LFD testing remains a crucial pillar of the testing strategy. Future studies should collect quantitative and qualitative data from residents to most effectively shape testing offers based on the needs and preferences of their population.

Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study.

BACKGROUND: There is limited understanding of the drivers of increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations. METHODS: Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1-April-2012 and 31-March-2019 were followed up for 1 year; from 1-April-2013 (from the discharge date of their birth admission) until their first birthday, death or 31-March-2019. Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted for individual-level factors and included a random effect for local authority (LA). RESULTS: The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendances and emergency admissions were highest amongst: infants born < 32 weeks gestation; with presence of congenital anomaly; and to mothers < 20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority. CONCLUSIONS: Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. The impact of these services requires further investigation. Substantial geographical variations in rates were not explained by individual-level factors. This suggests more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.

A systems approach to the exploration of research activity and relationships within a local authority.

BACKGROUND: Organizations with responsibilities for public health are increasingly required to use evidence-based practice to inform programme delivery, requiring research to generate relevant evidence, and dissemination and use of evidence to inform decisions and practices. Understanding how relationships between organizational structures, systems and processes influence evidence-based practices is critical to improving practice at both an institutional and system level, yet how these relationships should best operate is not well understood. Understanding how to better support research within local authorities, the elected administrative bodies responsible for services including public health at a regional level in the United Kingdom, is a priority for the National Institute for Health Research (NIHR) Public Health Research. This study is based on Norfolk County Council, a local authority in the east of England. We aimed to apply a systems perspective to develop a better understanding of the structures, systems and processes that support a local authority in becoming research-active, identifying gaps in understanding and recommendations for action to address them. METHODS: Taking a participatory action research approach, we applied qualitative methods to explore research activity and relationships in Norfolk County Council. We surveyed employees and used network analysis to map individuals, departments and external partners involved in research activities and the connections between them. We then applied participatory approaches to conduct a series of focus groups and semi-structured interviews to explore stakeholders' experiences and perceptions of being involved in research at, or with, the authority, and their ideas for recommendations for future actions. RESULTS: A range of research activity is undertaken at the local authority, with an emphasis on applied work to improve service delivery. We identified several examples of effective practice and models of research collaboration in some departments. Challenges such as limitations in resources, capacity and knowledge exchange were evident, yet there was a readiness amongst key stakeholders to develop and implement actions that may better support the authority in becoming more research-active. CONCLUSION: In large complex organizations, a key challenge is how to share learning across teams and implement good practice at an organizational and system level. Our findings highlight the potential for developing improved collaborative partnership models and systems to support sustainable processes and practices for research and knowledge exchange at an institutional and interorganizational level. The insights gained and shared will support other local authorities and similar large, multilevel organizations with responsibilities for evidence-based public health to explore their own setting and implement change where needed, and provide stimulus for further research into system-level change.

Building momentum for local action on problem gambling in Leeds and Yorkshire.

Problem gambling has not been a priority within either Leeds City Council or partnership plans. However, financial inclusion, licencing and public health teams have been able to develop a cross-Council approach to problem gambling. This has been aided by an upfront payment plus annual payments to the Council that have been part of the licencing agreement for a new casino. As a result, research has been commissioned on local prevalence. This showed a higher rate of problem gamblers (1.8%) than national estimates with a similar level to nationally of those 'at risk'. The research also showed that local services had difficulties identifying problem gamblers and signposting for support. This had led to a high profile communications campaign to coincide with 'Responsible Gambling Week' complemented by training for frontline workers. The interviews undertaken for the research, plus the findings themselves, have been a powerful help in securing interest and commitment beyond the Council and to the health and third sectors. The use of local stories has helped build momentum for partnership working. For example, focus groups to explore how gambling affected migrants and medical student interviews with university students. The article will describe how increasing understanding across partners has helped build confidence to provide cross city responses to national consultations and contribute to national publications and conferences. Of even greater significance, the local National Health Service has secured funding from GambleAware for a Northern Gambling Service to be based in Leeds with satellites in the North East and Greater Manchester. This will provide treatment for those with severe gambling addiction. Additional support will come from a significant increased provision of GamCare services working to identify, screen and support problem gamblers. The use of Council premises for both of these services is testament to joint working. Recognising that this is a new emerging agenda has led to the creation of a Yorkshire and Humber Problem Gambling Working Group, endorsed by the Association of Directors of Public Health. This has resulted in shared learning and determining a consistent approach to harm. Even during a short time, the degree of interest has risen substantially. A regional gambling harm reduction framework has been produced that sets out a menu of actions. This intends to help local areas determine their own priorities. There is increasing recognition that problem gambling is a public health issue. Leadership requires a systems led, and Health in All Policies, approach to ensure problem gambling is not seen as a narrow niche issue led by public health staff. There is a need to recognise that engagement takes time. However, this is a new and emerging issue. The solutions to problem gambling are not clear and this allows for more creative, pragmatic and coproduced approaches.

Gambling harm is everybody's business: A public health approach and call to action.

There is a growing consensus that gambling is a public health issue and that preventing gambling related harms requires a broad response. Although many policy decisions regarding gambling are made at a national level in the UK, there are clear opportunities to take action at local and regional levels to prevent the negative impacts on individuals, families and local communities. This response goes beyond the statutory roles of licencing authorities to include amongst others the National Health Service (NHS), the third sector, mental health services, homelessness and housing services, financial inclusion support. As evidence continues to emerge to strengthen the link between gambling and a wide range of risk factors and negative consequences, there is also a strong correlation with health inequalities. Because the North of England experiences increasing health inequalities, it offers an opportunity as a specific case study to share learning on reducing gambling-related harms within a geographic area. This article describes an approach to gambling as a public health issue identifying it as needing a cross-cutting, systemwide multisectoral approach to be taken at local and regional levels. Challenges at national and local levels require policy makers to adopt a 'health in all policy' approach and use the best evidence in their future decisions to prevent harm. A whole systems approach which aims to reduce poverty and health inequalities needs to incorporate gambling harm within place-based planning and draws on the innovative opportunities that exist to engage local stakeholders, builds local leadership and takes a collaborative approach to tackling gambling-related harms. This whole systems approach includes the following: (1) understanding the prevalence of gambling related harms with insights into the consequences and how individuals, their family and friends and wider community are affected; (2) ensuring tackling gambling harms is a key public health commitment at all levels by including it in strategic plans, with meaningful outcome measures, and communicating this to partners; (3) understanding the assets and resources available in the public, private and voluntary sectors and identifying what actions are underway; (4) raising awareness and sharing data, developing a compelling narrative and involving people who have been harmed and are willing to share their experience; (5) ensuring all regulatory authorities help tackle gambling-related harms under a 'whole council' approach.

The role of a local authority as a stakeholder encouraging the development of biogas: A study on territorial intermediation.

In a context where anaerobic digestion is a controversial subject, it is not surprising to see that between 20% and 30% of anaerobic digestion projects are abandoned, mainly for reasons of local opposition, problems of coordination between stakeholders and the implementation of real territorial governance capable of facing the challenges encountered during the setting up of the project. We can consequently question the role that local territorial authorities could play to encourage the development of biogas in France. We used semi-structured interviews conducted with anaerobic digestion stakeholders to identify the main functions of territorial intermediation (and their specific elements) that local authorities could have to encourage the deployment and success of these projects. Local authorities play the role of intermediation by (i) ensuring spatial and cognitive proximities between actors, (ii) mobilizing territorial resources and favoring local anchorage (iii) installing trust among the local stakeholders and (iv) having a role of instigator by participating in the supply (inputs) of biogas plants and the purchase of the energy produced (outputs).

Re H (A Child) (Parental Responsibility: Vaccination): The Merits of Adopting A Softer Approach To Vaccination of A Child in Care?

In Re H (A Child) (Parental Responsibility: Vaccination), the Court of Appeal decided that vaccination did not represent 'grave' or 'serious' medical treatment and determined that, in the case of a child under the care of a Local Authority, court authorization for consent to and arrangement of vaccination is no longer required. This is due to the strong medical evidence in support of vaccination. Thus, with due reference to 33(3)(b) Children Act 1989 and while considering proportionality and, particularly, the proportionate response to interference with the parents' right to respect for private and family life under Article 8 of the European Convention on Human Rights, the court held that vaccination is in line with the best interests of the child. This commentary supports this judgment but identifies a slight prospective anomaly in the approach adopted to children in care and those who are not in care. The resolution of this dichotomy lies in broadening the scope of King LJ's approach in this case.

Trajectories of change in childhood obesity prevalence across local authorities 2007/08-2015/16: a latent trajectory analysis.

BACKGROUND: We investigated differing trajectories of childhood obesity prevalence amongst English local authorities (LAs). METHODS: Data on prevalence of childhood obesity (BMI ≥ 95th centile) for Reception year and Year 6 for 150 LAs in England from 2006/07 to 2015/16 were obtained from the National Child Measurement Programme (NCMP). Latent class mixture modelling (LCCM) was used to identify classes of change in obesity prevalence. RESULTS: In Reception, most LAs showed little change across the period (Class 1; stable, moderate obesity prevalence;84%), with a smaller group with a high prevalence that fell thereafter (Class 2; high but falling obesity prevalence; 16%). In Year 6 we identified three classes: moderate obesity prevalence (Class 3; 43%); high and rising obesity prevalence (Class 2; 36%); and stable low obesity prevalence (Class 1; 21%). Greater LA deprivation and higher LA proportion of non-white ethnicity increased risk of being in Class 2 (Reception) or Class 2 or 3 (Year 6) compared with Class 1. CONCLUSIONS: The prevalence of childhood obesity in LAs in England follow a small number of differing trajectories that are influenced by LA deprivation and ethnic composition. LAs following a stable low obesity trajectory for Year 6 are targets for further investigation.

Cancer incidence and mortality in serving whole-time Scottish firefighters 1984-2005.

BACKGROUND: Firefighters may encounter uncontrolled exposure to carcinogens in their working environment. AIMS: To determine the incidence of, and mortality from, cancer in a cohort of ~2200 serving firefighters. METHODS: Service medical records were scrutinized for reports of malignancies. Age at recruitment and diagnosis was calculated, and annual incidence and mortality rates per 100000 population were derived and compared with age-matched male Scottish populations. RESULTS: Overall mean annual cancer incidence and mortality rates were lower in the firefighters (86.5 versus 123.7, P < 0.01, 95% confidence interval [CI] -290.3 to -209.7 and 20.4 versus 59.9, P < 0.001, 95% CI -57.5 to -22.5, respectively). The incidences of melanoma and kidney cancer were higher (13.6 versus 7.7, P < 0.001 95% CI 3.0 to 8.8 and 9.1 versus 4.4, P < 0.01, 95% CI 2.4 to 6.7) as was mortality from kidney cancer (6.5 versus 1.9, P < 0.01, 95% CI 2.8 to 6.4). Testicular cancer occurred more frequently than expected (9.1 versus 8.1), but did not reach statistical significance. Large bowel (9.1 versus 13.8), lung cancer (6.8 versus 20.4) and lymphoma (9.1 versus 11.0) all had a lower than expected incidence. This was significant regarding large bowel (P < 0.01, 95% CI -7.7 to -1.7) and lung (P < 0.001, 95% CI -7.7 to 1.0). Mortality was also lower--large bowel 4.5 versus 6.0, lung 4.5 versus 16.8 and lymphoma 2.3 versus 3.3, but this did not reach significance. Mean age and length of service at diagnosis were 43 years (range 28-54) and 19 years (range 2-31), respectively. CONCLUSIONS: These results are generally consistent with other studies of firefighters. The most common tumours were generally those associated with young and middle-aged men.

Making every contact count: an evaluation.

OBJECTIVES: To conduct an initial evaluation of a behaviour change programme called 'Making Every Contact Count' (MECC). STUDY DESIGN: Retrospective interview study. METHODS: In depth qualitative interviews with key stakeholders engaged in the delivery of MECC which were digitally recorded, transcribed and analysed thematically using framework analysis. RESULTS: The responses of those involved were generally favourable and although the 'intuitive' nature of the idea of Making Every Contact Count clearly resonated with interviewees, the take up was variable across different organisations. CONCLUSIONS: The approach to MECC described here was based on some of the principles outlined in the NICE Guidance on behaviour change published in 2007. The report shows that MECC has considerable potential for changing staff behaviour in relation promoting health enhancing behaviour among members of the general public coming into contact with services.

How do local authority plans to tackle obesity reflect systems thinking?

AIMS: A whole systems approach to tackling obesity has been recommended by Public Health England for several years. This qualitative study aimed to investigate whether systems thinking is reflected in local authority plans and strategies to tackle obesity, using the leverage points for intervention in a complex system, as a framework. METHOD: We sought to identify obesity strategies/plans for Southampton and 19 other local authority comparators (based on children's services and Office for National Statistics data). A healthy weight strategy was available for 10 local authorities and a qualitative document analysis was undertaken. The policy actions proposed in the plans were coded against the leverage points for intervention in a complex system and themes were developed to characterise interventions in each category. RESULTS: A majority of actions included in the plans were categorised as 'Numbers, Constants and Parameters' which reflect downstream measures. However, there were examples of actions that could act on higher leverage points. In addition, some local authority plans included interventions that could act on 10 of the 12 leverage points suggesting incorporation of systems thinking. CONCLUSIONS: Some local authority plans to tackle obesity do reflect systems thinking when viewed through the lens of the leverage points for intervention in a complex system. Interventions at higher leverage points should be prioritised by public health decision-makers, especially in a climate of competing agendas and limited resources.

Responding to COVID-19 pandemic at the local level: lessons from Yemen.

Background: The health authorities in Hadhramaut Valley and Desert responded to the COVID-19 pandemic differently from other areas in Yemen. Aims: To document the response of the local authority and Ministry of Health in Hadhramaut to COVID-19. Methods: The local authority in Syoun (Hadhramaut Valley) convened a meeting of all key players from the health and related sectors in February 2020 where a decision was made to establish a committee to evaluate the health situation and assess the needs. Based on the results of these assessments, a plan was designed to respond to the pandemic. We reviewed available documents on the COVID-19 response in Hadhramaut, interviewed the main stakeholders, and conducted site visits to the COVID-19 response centres. Results: There was evidence of the crucial role played by the local authority in response to COVID-19. They established 3 well-equipped isolation centres with a total of 142 beds, a stock of 2250 oxygen cylinders, 2 new polymerase chain reaction units, a simplified referral system, and an effective patient follow-up and oxygen home therapy strategy. Conclusion: Political commitment at the local level is crucial to bridge the gap between policy and implementation, especially during infectious disease outbreaks. It is important to train public health leaders on how to effectively assess local health needs and develop effective and efficient response strategy. Lessons from this study in Hadhramaut provide evidence on how local authorities can coordinate response to emerging health needs and update their strategies.

The association between social care expenditure and multiple-long term conditions: A population-based area-level analysis.

Background: Multiple long-term health conditions (MLTCs) are common and increasing among older people, yet there is limited understanding of their prevalence and association with social care expenditure. Aim: To estimate the prevalence of MTLCs and association with English social care expenditure. Methods: Our study population included those aged ≥ 65 who died in England in the year 2018 with any of the following long-term conditions recorded on their death certificate: diabetes; cardiovascular diseases (CVDs) including hypertension; dementia; stroke; respiratory; and chronic kidney diseases (CKDs). Prevalence was based on the proportion of death reported for older people with MTLCs (≥ 2) in each of the 152 English Local Authorities (LAs). Ordinary least square regression (OLS) was used to assess the relationship between prevalence of MTLCs and adult social care expenditure, adjusting for LA characteristics. Results: Of the 409551 deaths reported, 19.9% (n = 81395) had ≥ 2 MTLCs, of which the combination of CVDs-diabetes was the most prevalent. Hospitals were the leading place of death for those with MTLCs. Results from the OLS regression model showed that an increased prevalence of MLTCs is associated with higher LA social care expenditure. A percentage point increase in prevalence of MLTCs is associated with an increase of about £8.13 in per capita LA social care expenditure. Conclusion: Our findings suggest that the increased prevalence of MTLCs is associated with increased LA social care expenditure. It is important for future studies to further explore the mechanisms or link between LA social care expenditure and the prevalence of MTLCs.

Examining the influences on the use of behavioural science within UK local authority public health: Qualitative thematic analysis and deductive mapping to the COM-B model and Theoretical Domains Framework.

Background: Behavioural science and its contribution towards improving public health is receiving increased recognition. Yet, the translation of these insights into public health practice is under-researched. This study explored the factors influencing the use of behavioural science within public health at a local authority level. Methods: Fourteen local authority staff (n = 13 female) in the south of England participated in semi-structured interviews, which were analysed inductively to identify key themes. These were later mapped deductively to the COM-B model and Theoretical Domains Framework. Findings: Nine themes were identified as factors that influence the use of behavioural science in local authority public health: (1) "Limited past experience," (2) "Narrow understanding," (3) "Perceived value of behavioural science," (4) "Translational gap from theory-to-practice," (5) "No protected time," (6) "Old ways of working," (7) "Political influence and organisational culture," (8) "Relationships with key stakeholders," (9) "Access to behavioural science resources". Deductive mapping of these themes revealed that five of the COM constructs (excluding Physical Capability) and eleven of the TDF domains influenced behavioural science use, with "Social influences" and "Knowledge" being the most prominent. Discussion: Use of behavioural science within local authority public health practice is limited and inconsistent. For it to be successfully implemented, there must be an understanding of its role and value, alongside strategies to overcome a translational gap from theory to practice. Public health teams would benefit from protected time to enable application and strategies to break old habits of using a common-sense approach. System-wide buy-in, particularly related to senior leadership and system partners is needed, which would benefit from organisational and political culture change. Training opportunities, practical resources and expert in-house support should be considered a priority across public health teams.

Omicron SARS-CoV-2 epidemic in England during February 2022: A series of cross-sectional community surveys.

Background: The Omicron wave of COVID-19 in England peaked in January 2022 resulting from the rapid transmission of the Omicron BA.1 variant. We investigate the spread and dynamics of the SARS-CoV-2 epidemic in the population of England during February 2022, by region, age and main SARS-CoV-2 sub-lineage. Methods: In the REal-time Assessment of Community Transmission-1 (REACT-1) study we obtained data from a random sample of 94,950 participants with valid throat and nose swab results by RT-PCR during round 18 (8 February to 1 March 2022). Findings: We estimated a weighted mean SARS-CoV-2 prevalence of 2.88% (95% credible interval [CrI] 2.76-3.00), with a within-round effective reproduction number (R) overall of 0.94 (0·91-0.96). While within-round weighted prevalence fell among children (aged 5 to 17 years) and adults aged 18 to 54 years, we observed a level or increasing weighted prevalence among those aged 55 years and older with an R of 1.04 (1.00-1.09). Among 1,616 positive samples with sublineages determined, one (0.1% [0.0-0.3]) corresponded to XE BA.1/BA.2 recombinant and the remainder were Omicron: N=1047, 64.8% (62.4-67.2) were BA.1; N=568, 35.2% (32.8-37.6) were BA.2. We estimated an R additive advantage for BA.2 (vs BA.1) of 0.38 (0.34-0.41). The highest proportion of BA.2 among positives was found in London. Interpretation: In February 2022, infection prevalence in England remained high with level or increasing rates of infection in older people and an uptick in hospitalisations. Ongoing surveillance of both survey and hospitalisations data is required. Funding: Department of Health and Social Care, England.

Experiencing Event Management During the Coronavirus Pandemic: A Public Sector Perspective.

Events have played a significant role in the way in which the Coronavirus pandemic has been experienced and known around the world. Little is known though about how the pandemic has impacted on supporting, managing and governing events in municipal (i.e., local) authorities as key stakeholders, nor how events have featured in the opening-up of localities. This paper reports on empirical research with senior events officers for local authorities in the UK on these key knowledge gaps. Specifically, it examines events officers' unfolding experiences of the pandemic. The paper points to unpreparedness for a crisis of this scale and magnitude, and the roles of innovation, adaptation and co-production in the emergent response. It highlights the transformative nature of the pandemic through reconsiderations of the purpose of public sector involvement in events and, from a policy perspective, how relatively smaller-scale, more agile and lower-risk arts events and performances can figure in local recovery. Finally, while the effects on, and response of, the body corporate (the local authority) to crises is an obvious focus, it is important to recognise those of the individuals who manage the response and drive change.