Contribution of avoidable mortality to life expectancy inequalities in Wales: a decomposition by age and by cause between 2002 and 2020.

OBJECTIVES: To explore the contribution of avoidable mortality to life expectancy inequalities in Wales during 2002-2020. DESIGN: Observational study. SETTING: Wales, 2002-20, including early data from the COVID-19 pandemic. METHODS: We used routine statistics for 2002-2020 on population and deaths in Wales stratified by age, sex, deprivation quintile and cause of death. We estimated the contribution of avoidable causes of death and specific age-categories using the Arriaga decomposition method to highlight priorities for action. RESULTS: Life expectancy inequalities rose 2002-20 amongst both sexes, driven by serial decreases in life expectancy amongst the most deprived quintiles. The contributions of amenable and preventable mortality to life expectancy inequalities changed relatively little between 2002 and 2020, with larger rises in non-avoidable causes. Key avoidable mortality conditions driving the life expectancy gap in the most recent period of 2018-2020 for females were circulatory disease, cancers, respiratory disease and alcohol- and drug-related deaths, and also injuries for males. CONCLUSIONS: Life expectancy inequalities widened during 2002-20, driven by deteriorating life expectancy in the most deprived quintiles. Sustained investment in prevention post-COVID-19 is needed to address growing health inequity in Wales; there remains a role for the National Health Service in ensuring equitable healthcare access to alongside wider policies that promote equity.

The Privatization of the Italian National Health System and its Impact on Health Emergency Preparedness and Response: The COVID-19 Case.

Hospitals play a critical role in providing essential care during emergencies; however, this essential care can overwhelm the functional capacity of health systems. In Italy, substantial cuts in funding have drastically reduced the resources of the National Health Service (NHS) and contributed to the expansion of the private health sector which, unlike the public health system, does not have the capacity to deal with a health emergency such as coronavirus disease 2019 (COVID-19). The purpose of this article is to show how the privatization of the NHS contributed to making Italy more vulnerable and unprepared to tackle the COVID-19 pandemic. The available capacity and resources in the public and private emergency services systems in Italy are compared, including a focus on the numbers of hospital staff, hospitals, and hospital beds. The reduced funding and subsequent shortfalls in services in the NHS are reasons why extreme measures were needed to increase these resources during the COVID-19 pandemic. A public NHS in Italy would be better prepared for future health emergencies. The lessons learned from the COVID-19 pandemic can help to inform future health systems strategies, to halt the current financial decline and performance loss of national health systems, and to enable better preparation for future health emergencies.

The impact of the health-care sector on national economies in selected European countries.

Policy-makers face pressures to improve lives and safeguard public finances sustainably. In this analysis, we estimate the economic importance of the health-care sector in 19 European national economies. We use input-output tables for the year 2010 and sectoral data to estimate a set of multipliers: simple, total, truncated, type I and type II multipliers for output, income, value-added, employment and import multiplier. The analysis reveals similarities in the economic importance of the health-care sector for the national economies of the observed countries. Results suggest prevailing positive effects on national economies (value-added, employment and household income) when spending on health-care sector products and services increases, especially in comparison to the effects of increases in spending in other sectors. The importance of the health-care sector is connected to countries' levels of development; the benefits are especially promising in countries with lower levels of gross domestic product (GDP) per capita, where changes in the health-care sector have a larger impact on employment in the national economy than similar changes in more developed countries. The health-care sector therefore can play an important role as an instrument of economic policy.

Towards equity in immunisation.

In the World Health Organization (WHO) European Region, differences in uptake rates of routine childhood immunisation persist within and among countries, with rates even falling in some areas. There has been a tendency among national programmes, policymakers and the media in recent years to attribute missed vaccinations to faltering demand or refusal among parents. However, evidence shows that the reasons for suboptimal coverage are multifactorial and include the social determinants of health. At the midpoint in the implementation of the European Vaccine Action Plan 2015-2020 (EVAP), national immunisation programmes should be aware that inequity may be a factor affecting their progress towards the EVAP immunisation targets. Social determinants of health, such as individual and household income and education, impact immunisation uptake as well as general health outcomes - even in high-income countries. One way to ensure optimal coverage is to make inequities in immunisation uptake visible by disaggregating immunisation coverage data and linking them with already available data sources of social determinants. This can serve as a starting point to identify and eliminate underlying structural causes of suboptimal uptake. The WHO Regional Office for Europe encourages countries to make the equitable delivery of vaccination a priority.

Support for infants and young people with sight loss: a qualitative study of sight impairment certification and referral to education and social care services.

OBJECTIVES: To examine the experience of infants, children and their parents, the role of ophthalmologists and other health, social care and education professionals in the certification and registration processes and examine the relationship between certification and referrals and pathways to support. DESIGN: Qualitative study. SETTING: Telephone interviews with health and, social care professionals, qualified teachers of children and young people with vision impairment (QTVIs) and parents of infants/children in England. PARTICIPANTS: 52 health, social care and education professionals who are part of the certification or registration process. 26 parents of infants and children with vision impairment. RESULTS: Referrals to education do not require a Certificate of Vision Impairment (CVI); however, the majority of parents received support from education and social services only after an offer of the CVI, which was often dependent on having a formal diagnosis. Parents stated they wanted support sooner, particularly parents of children with additional complex needs who experienced longer delays. Areas with multidisciplinary teams and support roles such as eye clinic liaison officers (ECLOs) appeared to have more reliable referral pathways. CONCLUSIONS: For infants and children with vision impairment, there should be a consistent mechanism for triggering education and social care support even with uncertainty about diagnosis and/or prognosis. All professionals involved in the certification and registration processes (ophthalmologists, optometrists, ECLOs, orthoptists, social workers, QTVIs) can better communicate the value and benefits of certification and registration.

Addressing health inequalities in the delivery of the human papillomavirus vaccination programme: examining the role of the school nurse.

BACKGROUND: HPV immunisation of adolescent girls is expected to have a significant impact in the reduction of cervical cancer. UK The HPV immunisation programme is primarily delivered by school nurses. We examine the role of school nurses in delivering the HPV immunisation programme and their impact on minimising health inequalities in vaccine uptake. METHODS AND FINDINGS: A rapid evidence assessment (REA) and semi-structured interviews with health professionals were conducted and analysed using thematic analysis. 80 health professionals from across the UK are interviewed, primarily school nurses and HPV immunisation programme coordinators. The REA identified 2,795 articles and after analysis and hand searches, 34 relevant articles were identified and analysed. Interviews revealed that health inequalities in HPV vaccination uptake were mainly related to income and other social factors in contrast to published research which emphasises potential inequalities related to ethnicity and/or religion. Most school nurses interviewed understood local health inequalities and made particular efforts to target girls who did not attend or missed doses. Interviews also revealed maintaining accurate and consistent records influenced both school nurses' understanding and efforts to target inequalities in HPV vaccination uptake. CONCLUSIONS: Despite high uptake in the UK, some girls remain at risk of not being vaccinated with all three doses. School nurses played a key role in reducing health inequalities in the delivery of the HPV programme. Other studies identified religious beliefs and ethnicity as potentially influencing HPV vaccination uptake but interviews for this research found this appeared not to have occurred. Instead school nurses stated girls who were more likely to be missed were those not in education. Improving understanding of the delivery processes of immunisation programmes and this impact on health inequalities can help to inform solutions to increase uptake and address health inequalities in childhood and adolescent vaccination programmes.

Health promotion and ill-health prevention: the role of general practice.

BACKGROUND: This paper reports on research undertaken for the King's Fund inquiry into quality in general practice and examines the health promotion role of the general practitioner. METHODS: Literature review of health promotion in general practice focusing on smoking cessation, childhood immunisation, coronary heart disease (CHD) and obesity. In addition the paper draws on interviews with practice and public health staff. RESULTS: General practitioners (GPs) and their practice teams have a crucial role in promoting health and preventing disease. Consultations provide an ideal opportunity for preventing illness and disease but general practice focuses primarily on secondary prevention. Many GPs state they lack the skills needed to deliver effective health promotion. CONCLUSIONS: Issues, such as GP commissioning, provide a new set of challenges for public health and ill-health prevention. The evidence base is growing but general practice, public health and academics need to work together to improve this.

Helping patients choose: how to improve the design of comparative scorecards of hospital quality.

OBJECTIVE: To understand how the public understand comparative quality information as presented on NHS Choices, the Department of Health website in England. We explore what quality information people value, how they understand different measures of quality, and their preferences for different types of information. METHOD: Seven focus groups were conducted. RESULTS: Participants' preferences for types of information changed at different stages of the focus groups. Participants attempted to compare hospitals option-wise, building up an overall picture of the hospital's performance. Faced with abundance of conflicting criteria, participants attempted to make trade offs, but found it difficult. Older and less numerate participants used summative measures to overcome this difficulty. Some indicators were poorly understood and the multiplicity of formats and labels was confusing. Missing data were mistrusted. CONCLUSION: The presentation of information affects what information people value, how they understand and process it. The design of scorecards is crucial in order to support use of scorecards for informed patient choice. PRACTICE IMPLICATIONS: We offer guidelines for changing presentation of comparative quality information with the aim to improve its use by patients when choosing between hospitals, especially online.