By Siobhan O’Connor:
A snapshot of this year’s Kings Fund Digital Health and Care Congress in London highlighted the focus on enabling patient-centred care through information and technology. Beverley Bryant, Director of Digital Technology for NHS England outlined the NHS’s Five Year Forward View and the Department of Health’s Personalised Health and Care 2020 framework. These two important strategy documents outline how health services in the United Kingdom will be transformed through information technology over the next fives years.
At the heart of these are a number of key commitments including:
- Patients will have access to and write into their health records,
- Citizens will have a single point of access to all their health transactions,
- NHS111 urgent care services will be digitised and linked to nhs.uk,
- uk will be customizable to reflect specific local needs,
- Personalized, mobile care record for parents of newborns will be tested,
- The impact of digital developments on inclusion and equity across the care spectrum will be considered,
- Individual digital care accounts will be piloted.
These promise to address some current issues between health and social care such as a poor ‘customer’ experience, digital exclusion, security concerns in relation to accessing health data, the modernization of the underlying technical infrastructure and working across professional silos among others.
In particular, Beverly highlighted the progress made in primary care with greater flexibility in booking GP appointments online, better access to electronic prescriptions, more ways to communicate with family doctors over web-based media and now plans are underway to enable patients to register with a GP practice online to further reduce bureaucracy and remove barriers to access for citizens.
The crux of her discussion was taken up by Dr Paul Rice, Head of Technology Strategy for NHS England, who went on to outline a roadmap for local delivery of these strategies in the form of a digital maturity programme. This requires NHS trusts to have a number of key organisational capabilities including decision support, asset and resource optimisation, remote and assistive care and citizen activation. Some practical examples were given of current roadmaps in Bristol and Cumbria to demonstrate how trusts can move towards a paper-free environment by 2020.
So what does all this mean for researchers in the health and wellbeing fields? Well as always, robust evidence is required to underpin these new approaches, validate them as worthwhile investments and explore their impact on the health and social care landscape in the UK. So if you have an interest in all things eHealth then check out the presentations from all the speakers at this year’s King’s Fund conference here.
Patients in control of own info is ‘on roadmap’ says @PaulRiceNHS. Doc/patient views on online records: http://www.kingsfund.org.uk/reports/thefutureisnow/#patient-and-doctor-views #kfdigital15
By David Blane
Neoliberalism is bad for your health. That was the take-home message from Professor Paul Bissell, the invited speaker for the Institute of Health & Wellbeing’s Maurice Bloch seminar series on April 20th 2015. Prof Bissell began his talk by summarizing the now familiar arguments of Richard Wilkinson and Kate Pickett, from their book The Spirit Level. Their main thesis, supported with considerable empirical evidence, is that those advanced capitalist countries with the greatest income inequality do worse across a range of health and social outcomes compared to those that are more equal (a case also made in a recent IHAWKES Election Special guest blog by Professor Andy Gumley). Continue Reading
By Anna Isaacs
It has been seven years since the WHO Commission on the Social Determinants of Health launched its report demonstrating categorically the profound impact of social and economic inequalities on health outcomes and declaring that “social injustice is killing people on a grand scale”. The powerful effects of socioeconomic, structural and political influences over individual behaviours on our health are well known and well discussed. Yet, so often in public health research, we seem to park this knowledge at the door and continue working on behavioural health interventions that bring minimal, short-term benefits, if any at all. We may nod to the importance of culture, or socio-economic status, or even incorporate a socio-ecological perspective, but it is incredibly rare for such research to challenge, or even examine, the more fundamental factors that result in ill health. Continue Reading
By Camilla Baba:
A debate in the Lancet co-authored by Dame Sally Davies, which addresses the ‘fifth wave’ in public health, recently caught my attention. Hanlon et al first discussed the concept of a ‘fifth wave’ in public health in 2011, suggesting that current challenges in public health require a delivery approach where a culture of healthy choices and behaviours is the norm. In their recent piece, Davies and colleagues (2014) consider practical approaches for the fifth wave. They preface this by charting the history of the various ‘waves’ of public health, suggesting that each links to a major shift in thinking about the nature of society and health. If we think back to the period of the late 19th – early 20th century, social medicine identified the link between unsanitary living conditions and the spread of disease (see Chadwick’s report). In this first wave, structural works such as the provision of clean water to urban areas became a priority. Wave two spanned the late 19th to the mid- 20th century. Modern technology gave rise to hospitals and the concept of an ‘expert’ was born. This led to theories of disease that are still applied today. The end of WWII saw great social change, as the welfare state was first conceived. The role of our everyday life and lifestyles on our health was explored. This was wave three (1940-1980) in action! Mid-20th century onwards has been dominated by efforts to combat disease risk and by the emergence of systems thinking. Health has an agenda item for policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health.
Why a fifth wave?
Hanlon et al suggest that a ‘fifth wave’ in public health is necessary as a means to address serious issues such as social inequalities, loss of wellbeing (rise in depression and anxiety) and obesity, which are occurring in a context where society is also facing challenges due to “the broader problems of exponential growth in population, money creation and energy usage” (2011). Simply put, something has to give and necessity requires a new approach to public health.
The authors suggest a health-promoting societal context where healthy behaviours are the norm and a multi-sector (holistic) approach is taken to ensure this is promoted by our physical, social and economic environments. They argue that 3 practical mechanisms could be used:
- Value of health – reward healthy behaviours and create social and institutional environments to encourage healthy choices;
- Healthy choices as default – at the point of decision-making, address health consequences of choices;
- Minimise influences to unhealthy behaviour – eradicate factors that can encourage unhealthy behaviours (e.g. the Public Health Responsibility Deal)
The importance of marketing and financial incentives in the new drive for public health is stressed. Yet, with the current economic climate I am not convinced. Can we truly tackle these challenges by relying on manufacturers/corporate bodies and their commitment to the ‘common good’? Would that be financially feasible for them and a profitable business model? As a budding health economist I hear myself asking how much profit would they trade for these non –monetary gains? With an increasing percentage of the population living below the poverty line, is a more radical approach needed? As demonstrated by the recent television show ‘The Great British Budget Menu’, healthier choices are often a luxury for those facing food poverty. Perhaps we can go further and make public health the sole priority in the UK. Rather than the’ easier’ option, why not the ‘only’ option? After all, looking back, previous waves have all included a radical aspect in their approaches.
What do you think? Are we in need of a new wave in public health? Have Davies et al got it right? Leave your comments below and continue the debate!
BBC. (2013). The Great British Budget Menu http://www.bbc.co.uk/programmes/b036x3pv aired 02/08/2013
Davies, S.C., Winpenny, E., Ball, S., et al. (2014). For debate: a new wave in public health improvement. The Lancet. E-pub: 03/04/2014.
Hanlon P, Carlisle S et al. (2011). Making the case for a ‘fifth wave’ in public health. Public Health 125,1:30-36.
The Victorian Web. (2002). Chadwick’s Report on Sanitary Conditions. http://www.victorianweb.org/history/chadwick2.html
By Olivia Kirtley:
I am currently the IHAWKES roving reporter at Columbia University, New York City. Just one of the many intriguing pieces of research to come out of Columbia Psychiatry recently, is a Lancet Psychiatry article by Professor Madelyn Gould and other colleagues from Dartmouth College and Tufts University, looking at how the reporting of suicide in newspapers may be involved in teenage suicide clusters. Point clusters of suicides are when a higher than expected number of suicides occur within a shorter than average time period, e.g. a week or a year; and/or in a similar space, such as within an individual school, or town (Mesoudi, 2009).
Gould et al’s study looked at all suicide clusters that occurred in 13-20 year olds in the US, from 1988-1996, and matched them to other non-clustered suicides. The researchers then examined newspapers that were published after the index cluster or non-cluster suicide from each area where suicides occurred, and searched for stories relating to suicide, e.g. a headline including “suicide” or another word/phrase suggesting a person had taken their own life.
Findings show that in areas where cluster suicides occurred, there were significantly more news stories published about suicide than in areas where the index suicide was not followed by another death. These news stories were also more likely to be front-page news, give more details about the individual and the method of suicide and also to use sensationalist headlines containing the word suicide or the method used. Crucially, subsequent suicide deaths were specifically associated with stories about suicidal individuals rather than with general stories that included suicide related content. Whilst the findings from this study do not demonstrate that overly explicit and detailed news reporting about individuals who die by suicide causes subsequent suicides, it does show an association. The authors urge caution, however, as suicide is complex and usually involves many different factors, of which exposure to news stories may only be one.
Indeed, not all suicides are reported in the media. What is it about one suicide relative to another that makes it newsworthy? Another recent study by Machlin, Pirkis and Spittal (2013) from the University of Melbourne, investigated the characteristics of suicides that were reported in the press and whether or not these suicides had specific features which may have made them more likely to hit the headlines. They looked at data on suicides collected by the National Coroners Information System and also radio, TV and newspaper reports that included the word suicide which occurred from 2006-2007. Suicides reported in the media were significantly more likely to be those of younger people (29 years or younger), to involve violent methods (e.g.,firearms) or to occur in an institutional setting (e.g., a hospital). In addition to potentially leading to copycat suicides, sensationalist reporting of suicides in the media can also affect how the public understands suicide, maybe leading to the idea that particular groups of people are the only ones at risk of suicide.
This research highlights the critical importance of sensitively reporting suicide in the media and the crucial role the media has to play in suicide prevention. There are both national and international guidelines for media reporting of suicide, including from from the Samaritans in the UK and the International Association for Suicide Prevention and World Health Organization internationally. The guidelines advise against giving detailed descriptions of the method that a person has used to kill themselves or the location of the death, as this could provide a “how to guide” for someone who is vulnerable and considering ending their life. The media guidelines for suicide reporting are supported by a wealth of scientific evidence and are intended not as bureaucratic red tape or media censorship, but quite simply, to save lives.
Gould, M. S., Kleinman, M. H., Lake, A. M., Forman, J., & Bassett Midle, J. (2014). Newspaper coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988—96: a retrospective, population-based, case-control study. Lancet Psychiatry. Advance online publication. doi: 10.1016/S2215-0366(14)70225-1
International Association of Suicide Prevention & World Health Organization. (2008). Preventing Suicide: A Guide for Media Professionals. Retrieved from http://www.who.int/mental_health/prevention/suicide/resource_media.pdf
Machlin, A., Pirkis, J., & Spittal, M. J. (2013). Which Suicides Are Reported in the Media – and What Makes Them “Newsworthy”? Crisis, 34(5), 305–313. doi:10.1027/0227-5910/a000177
Mesoudi, A. (2009). The Cultural Dynamics of Copycat Suicide. PLoS ONE, 4(9), e7252. doi:10.1371/journal.pone.0007252
Samaritans. (2014). Media Guidelines for the Reporting of Suicide. Retrieved from http://www.samaritans.org/media-centre/media-guidelines-reporting-suicide