A case study of new approaches to address health inequalities: Due North five years on

2019 ◽  
Vol 132 (1) ◽  
pp. 17-31
Author(s):  
Paul W Johnstone
Keyword(s):  
Public Health ◽  
Local Government ◽  
Health Inequalities ◽  
Annual Reports ◽  
New Approaches ◽  
The North ◽  
New Public Health ◽  
The Impact ◽  
Deprived Areas

Abstract Introduction When local councils took on responsibility for public health in England in 2013, leaders from across the north of England met to consider the scale of the challenge. As a result, Public Health England commissioned the Due North Report which outlined new approaches in tackling health inequalities. This second paper outlines what has been learnt in five years as a case study. This includes influencing devolution deals and new elected city mayors, planning for economic growth in deprived areas and developing community asset-based approaches. The paper outlines a new framework for place-based planning to reduce health inequalities. Sources of data Data was gathered from annual reports from north of England directors of public health, Office for National Statistics, Public Health England’s fingertips database and regional and national publications and strategies such as the Northern Powerhouse. Areas of agreement Devolution to English cities and councils as ‘places’ is a new opportunity to address local needs and inequalities. Due North has supported a new public health narrative which locates health action in the most fundamental determinants—how local economies are planned, jobs created and power is to be transferred to communities and connects reducing years of premature ill health to increased economic productivity. Community asset approaches to empower local leaders and entrepreneurs can be effective ways to achieve change. Areas of controversy The north–south divide in health is not closing and may be worsening. Different ways of working between local government, health and business sectors can inhibit in working together and with communities. Growing points Place-based working with devolved powers can help move away from top down and silo working, empower local government and support communities. Linking policies on health inequalities to economic planning can address upstream determinants such as poverty, homelessness and unsafe environments. Areas timely for developing research More research is needed on; (i) addressing inequalities at scale for interventions to influence community-led change and prosperity in deprived areas, and (ii) the impact of devolution policy on population health particularly for deprived areas and marginalised group. Discussion and conclusions Commissioning high profile reports like Due North is influential in supporting new approaches in reducing inequality of health through local government, elected mayors; and working with deprived communities. This second paper describes progress and lessons.

A general practice provider federation in a mixed health economy in England: a case study investigation

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696929
Author(s):  
Jill Mitchell
Keyword(s):  
General Practice ◽  
Shared Vision ◽  
Health Economy ◽  
Structured Interviews ◽  
The North ◽  
Common Strategy ◽  
Common Purpose ◽  
Collaborative Working ◽  
The Impact

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

Ten Demi-Culverins for Aldeburgh: Whitehall, the Dunkirkers, and a Suffolk Fishing Community, 1625–1630

2019 ◽  
Vol 58 (2) ◽  
pp. 315-337 ◽  
Author(s):  
Thomas Cogswell
Keyword(s):  
North Sea ◽  
East Coast ◽  
Central Government ◽  
Fishing Community ◽  
Close Attention ◽  
The North ◽  
The North Sea ◽  
The Impact

AbstractHistorians have not paid close attention to the activities of freebooters operating out of Dunkirk in the late 1620s. This essay corrects that omission by first studying the threat from Dunkirk to England's east coast and then addressing how the central government, counties, and coastal towns responded. A surprisingly rich vein of manuscript material from Great Yarmouth and particularly from the Suffolk fishing community of Aldeburgh informs this case study of the impact of this conflict around the North Sea.

Traditionalism and politics: A case study of Northern Nigeria

1967 ◽  
Vol 2 (4) ◽  
pp. 509-524 ◽  
Author(s):  
B. J. O. Dudley
Keyword(s):  
Social Change ◽  
Local Government ◽  
Status Quo ◽  
Political Elite ◽  
High Time ◽  
The Political ◽  
Northern Nigeria ◽  
The North ◽  
The Right

In the debate on the Native Authority (Amendment) Law of 1955, the late Premier of the North, Sir Ahmadu Bello, Sardauna of Sokoto, replying to the demand that ‘it is high time in the development of local government systems in this Region that obsolete and undemocratic ways of appointing Emirs’ Councils should close’, commented that ‘the right traditions that we have gone away from are the cutting off of the hands of thieves, and that has caused a lot of thieving in this country. Why should we not be cutting (off) the hands of thieves in order to reduce thieving? That is logical and it is lawful in our tradition and custom here.’ This could be read as a defence against social change, a recrudescence of ‘barbarism’ after the inroads of pax Britannica, and a plea for the retention of the status quo and the entrenched privilege of the political elite.

scholarly journals Exploring the local policy context for reducing health inequalities in children and young people: an in depth qualitative case study of one local authority in the North of England, UK

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eleanor Holding ◽  
Hannah Fairbrother ◽  
Naomi Griffin ◽  
Jonathan Wistow ◽  
Katie Powell ◽  
...  
Keyword(s):  
Child Health ◽  
Social Determinants Of Health ◽  
Health Inequalities ◽  
Social Determinants ◽  
Qualitative Case Study ◽  
Determinants Of Health ◽  
Local Policy ◽  
Inequalities In Health ◽  
The North

Abstract Background Improving children and young people’s (CYP) health and addressing health inequalities are international priorities. Reducing inequalities is particularly pertinent in light of the Covid-19 outbreak which has exacerbated already widening inequalities in health. This study aimed to explore understandings of inequality, the anticipated pathways for reducing inequalities among CYP and key factors affecting the development and implementation of policy to reduce inequalities among CYP at a local level. Methods We carried out a qualitative case study of one local government region in the North of England (UK), comprising semi structured interviews (n = 16) with service providers with a responsibility for child health, non-participant observations of key meetings (n = 6 with 43 participants) where decisions around child health are made, and a local policy documentation review (n = 11). We employed a novel theoretical framework, drawing together different approaches to understanding policy, to guide our design and analysis. Results Participants in our study understood inequalities in CYP health almost exclusively as socioeconomically patterned inequalities in health practices and outcomes. Strategies which participants perceived to reduce inequalities included: preventive support and early intervention, an early years/whole family focus, targeted working in local areas of high deprivation, organisational integration and whole system/place-based approaches. Despite demonstrating a commitment to a social determinants of health approach, efforts to reduce inequalities were described as thwarted by the prevalence of poverty and budget cuts which hindered the ability of local organisations to work together. Participants critiqued national policy which aimed to reduce inequalities in CYP health for failing to recognise local economic disparities and the interrelated nature of the determinants of health. Conclusions Despite increased calls for a ‘whole systems’ approach to reducing inequalities in health, significant barriers to implementation remain. National governments need to work towards more joined up policy making, which takes into consideration regional disparities, allows for flexibility in interpretation and addresses the different and interrelated social determinants of health. Our findings have particular significance in light of Covid-19 and indicate the need for systems level policy responses and a health in all policies approach.

scholarly journals A tale of two parts of Switzerland: regional differences in the impact of the COVID-19 pandemic on parents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michelle Seiler ◽  
Georg Staubli ◽  
Julia Hoeffe ◽  
Gianluca Gualco ◽  
Sergio Manzano ◽  
...  
Keyword(s):  
Public Health ◽  
Regional Differences ◽  
Online Survey ◽  
Pediatric Emergency ◽  
The South ◽  
Public Health Agencies ◽  
The North ◽  
Regional Strategies ◽  
Health Agencies ◽  
The Impact

Abstract Background We aimed to document the impact of the coronavirus disease 2019 (COVID-19) pandemic on regions within a European country. Methods Parents arriving at two pediatric emergency departments (EDs) in North of Switzerland and two in South of Switzerland completed an online survey during the first peak of the pandemic (April–June 2020). They were asked to rate their concern about their children or themselves having COVID-19. Results A total of 662 respondents completed the survey. Parents in the South were significantly more exposed to someone tested positive for COVID-19 than in the North (13.9 and 4.7%, respectively; P <  0.001). Parents in the South were much more concerned than in the North that they (mean 4.61 and 3.32, respectively; P <  0.001) or their child (mean 4.79 and 3.17, respectively; P <  0.001) had COVID-19. Parents reported their children wore facemasks significantly more often in the South than in the North (71.5 and 23.5%, respectively; P <  0.001). Conclusion The COVID-19 pandemic resulted in significant regional differences among families arriving at EDs in Switzerland. Public health agencies should consider regional strategies, rather than country-wide guidelines, in future pandemics and for vaccination against COVID-19 for children.

scholarly journals Evaluating the efficacy of technical measures: a case study of selection device legislation in the UK Crangon crangon (brown shrimp) fishery

2008 ◽  
Vol 65 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Tom L. Catchpole ◽  
Andrew S. Revill ◽  
James Innes ◽  
Sean Pascoe
Keyword(s):  
Brown Shrimp ◽  
Crangon Crangon ◽  
Shrimp Fishery ◽  
The North ◽  
Ex Post ◽  
Wide Range ◽  
The Uk ◽  
The Impact ◽  
Technical Measures

Abstract Catchpole, T. L., Revill, A. S., Innes, J., and Pascoe, S. 2008. Evaluating the efficacy of technical measures: a case study of selection device legislation in the UK Crangon crangon (brown shrimp) fishery. – ICES Journal of Marine Science, 65: 267–275. Bycatch reduction devices are being introduced into a wide range of fisheries, with shrimp and prawn fisheries particularly targeted owing to the heavy discarding common in these fisheries. Although studies are often undertaken to estimate the impact of a technical measure on the fishery before implementation, rarely have the impacts been assessed ex post. Here, the efficacy of the UK legislation pertaining to the use of sievenets in the North Sea Crangon crangon fishery is assessed. Three impacts were evaluated: on fisher behaviour (social), on the level of bycatch (biological), and on vessel profitability (economic). An apparent high level of compliance by skippers was identified despite a low level of enforcement. The estimated reduction in fleet productivity following the introduction of the legislation was 14%, equalling the mean loss of Crangon landings when using sievenets calculated from catch comparison trawls. Sievenets did reduce the unnecessary capture of unwanted marine organisms, but were least effective at reducing 0-group plaice, which make up the largest component of the bycatch. Clearly the legislation has had an effect in the desired direction, but it does not address sufficiently the bycatch issue in the Crangon fishery.

scholarly journals Integrating quasi-experimental and inductive designs in evaluation: A case study of the impact of free bus travel on public health

Evaluation ◽  
2015 ◽  
Vol 21 (4) ◽  
pp. 391-406 ◽  
Author(s):  
Judith Green ◽  
Helen Roberts ◽  
Mark Petticrew ◽  
Rebecca Steinbach ◽  
Anna Goodman ◽  
...  
Keyword(s):  
Public Health ◽  
Quasi Experimental ◽  
The Impact

scholarly journals Disparities by deprivation: The geographical impact of unprecedented changes in local authority financing on the voluntary sector in England

2021 ◽  
pp. 0308518X2110348
Author(s):  
David Clifford
Keyword(s):  
Local Government ◽  
Local Authority ◽  
Voluntary Sector ◽  
Recent Change ◽  
Revolutionary Change ◽  
Disadvantaged Communities ◽  
Local Government Finance ◽  
History Of ◽  
The Impact ◽  
Deprived Areas

Over the last decade, the local government finance system in England has experienced ‘genuinely revolutionary change’: overall revenues have declined and councils are now more reliant on locally raised taxes. Importantly, the nature of change has varied geographically: urban councils serving poorer communities have experienced the biggest declines in their service spending. This paper considers the impact of these spatially uneven changes on the voluntary sector. We follow through time charities known to be in receipt of local government funding at the time of peak council budgets in 2009–2010 and describe trends in the income of these charities until 2016–2017. We show that, just as the pattern of change in local government financing has been spatially uneven, so the trend in charities’ income has varied geographically. Indeed the spatially regressive nature of recent change in charities’ income is remarkable: while the median charity in the least deprived decile of the local authority distribution experienced little change in their income, the median charity in the most deprived decile experienced a 20% decline. The results provide the strongest evidence to date that, in countries with a history of partnership between government and the voluntary sector, voluntary organisations in more deprived areas are particularly vulnerable to sizeable reductions in the level of local government spending. Indeed, by illustrating for the first time the sizeable reductions in the income of charities in disadvantaged communities, the results demonstrate an important mechanism through which ‘austerity urbanism’ becomes salient in the lives of individuals in deprived areas.

scholarly journals Issues on Takaful Affecting the Choice of Accounting Policies: A Case Study of Two Takaful Companies in Malaysia

2010 ◽  
Vol 3 (3) ◽  
pp. 187 ◽  
Author(s):  
Hairul Azlan Annuar ◽  
Nur Barizah Abu Bakar
Keyword(s):  
Central Bank ◽  
Advisory Council ◽  
Annual Reports ◽  
Case Study Method ◽  
Financial Reports ◽  
Descriptive Case Study ◽  
Senior Official ◽  
Similarities And Differences ◽  
The Impact

The paper adopts a descriptive case study method to examine the impact of juristic views on the operations of two Malaysian takaful companies. In order to achieve this objective, the annual financial reports of both companies were analysed. Interviews with each company’s finance managers and with a member of the Malaysian Shariah Advisory Council were undertaken for a more in-depth coverage. Also a written correspondence with a senior official of the central bank was accomplished. Similarities and differences between the two companies were identified and it is concluded that the differences are serious enough to warrant interventions from the regulators in the form of mandatory disclosures in the annual reports. 

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