Welcome to the Summer edition of the SCPHRP magazine, our second edition of 2017
We have had a busy 2017 so far at SCPHRP, we’ve said hello to a whole load of new people and said goodbye to a few. In this edition of the magazine we are sharing updates on some of the exciting projects we’ve been working on including our Citizen Science project, the 20mph Research Study, an Obesity Landscape project, and our Stand Up for Health project (which comes with a creative video from film-maker Felix Adamson). Hope you enjoy.
We would appreciate any feedback you have on what you like or what we could improve. If you have any, please send it to Sam at firstname.lastname@example.org. Thanks
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The POWER Study (Project for an Ontario Women’s Health Evidence-Based Report) produced a comprehensive Women’s Health Equity Report designed to provide actionable data for policy makers, providers, and consumers in their efforts to improve health and reduce health inequities in Ontario (www.powerstudy.ca).
Health inequities were assessed using a comprehensive set of evidence-based indicators bridging population health and health care for the leading causes of morbidity and mortality among women and men. The study examined gender differences, and also explicitly examined differences between diverse groups of women.
Sizable and modifiable inequities in health and health care on multiple measures were identified. Inequities in health status were much greater than inequities in access to and quality of care. Inequities in screening and chronic disease management were greater than inequities in care of acute conditions. Insights and lessons learned will be discussed.
Richard E. Tremblay is professor of paediatrics, psychiatry and psychology at the Université de Montréal and professor of child development at the University College Dublin, Ireland; known throughout the world for his innovative research on socialization and the prevention of violence in children. He has published widely in scientific journals, books and websites. Named as one of Canada’s top five researchers by ‘Time’ magazine and featured in ‘Science’.
ABSTRACT: Professor Clyde Hertzman is a social epidemiologist with a distinguished scientific career, who has devoted the last 15 years to both study and action on arguably the most important determinant of lifelong health and function: early life. He has published many papers demonstrating the close links between early life experiences, especially the social environment around and within the family, and the achievement of full human potential across socio-economic groups in modern society. Furthermore, he has consistently expounded the view that early life is, of all the determinants of health, by far the most amenable to policies and programs to reduce socio-economic inequalities in health, in any reasonable timeframe. Proven pre-primary child development programs can ’level the playing field of life’ for a birth cohort within just a few years of initiation.
Over the last several years, Prof. Hertzman has established and directed the Human Early Learning Partnership at UBC in Vancouver, an applied research and knowledge transfer/exchange unit, funded from public sources. It is dedicated to the population-level measurement, and prompt community feedback, of novel indicators of child developmental health ’ especially the Early Development Instrument (EDI), a twenty-minute fully validated questionnaire that assesses ’readiness to learn,’ which is now completed by kindergarten teachers in every British Columbia school every few years. [This instrument has been clearly demonstrated to predict primary school achievement, and in turn ’life success,’ which correlates highly to lifelong health and function ’ it is therefore a sensitive indicator of social inequalities in health at the community level.]
The EDI results from all British Columbia’s far-flung communities are extensively analysed by HELP, using in particular data depiction methods accessible to lay persons. These data are then fed back promptly to local communities, including school boards, parents and teachers. Part of the analysis allows these takeholders to judge how their local children entering school that year are doing in developmental terms, compared to both previous birth cohorts in that setting, and same-aged cohorts of children in socio-economically matched settings across the province. Similar programs of population-wide measurement utilizing the EDI are in place in parts of Australia, and are being piloted in several other countries.
A key benefit to participating communities is the complete separation of these measurements from the contentious issue of school performance per se. Because these measures are taken when indergartners (typically five years of age in Canada) are only a few months into their first formal school experience, the results cannot be used to ’blame the schools for below-average performance.’ Rather, the results are invaluable as resources, to local schools and communities, in advocating for additional resources to both improve future birth cohorts’ readiness to learn at school entry, via pre-primary child development programs of established effectiveness, and remedial instruction for those already in school. The HELP program thus works to the advantage of the disadvantaged, at a local level, while also providing sensitive ’ and potentially promptly reversible ’ measures of human developmental health, at any level of aggregation in an entire population, that is relevant to program and policy decision-making.
Dr J David Hawkins is the Endowed Professor of Prevention and Founding Director of the Social Development Research Group, School of Social Work, University of Washington, Seattle. He received his B.A. in 1967 from Stanford University and his Ph.D. in Sociology from Northwestern University in 1975. His research focuses on understanding and preventing child and adolescent health and behaviour problems.
He is principal investigator of the Community Youth Development Study, a randomized field experiment involving 24 communities across seven states testing the effectiveness of the Communities That Care prevention system developed by Hawkins and Richard F. Catalano. He has authored numerous articles and several books as well as prevention programs for parents and families, including Guiding Good Choices, Parents Who Care, and Supporting School Success. His prevention work is guided by the social development model, his theory of human behaviour.
Talk 1: Rob Young, MRC Functional Genomics Unit, University of Oxford: What is the shape of the dose-response relationship between markers of socioeconomic status and health status indicators?
The association between socioeconomic status (SES) and health status has been extensively studied as a linear one, but this assumption of linearity is rarely tested. We have developed a novel technique based on spline theory which calls turning points, known as ’knots’, within this linear relationship. Both the number and the position of these knots can be estimated using various standard regression models. The results of this modelling are summarised graphically and by two summary statistics ’ the Population Attributable Risk (PAR) and the Relative Index of Inequality (RII). We have used this approach to observe a significant increase in the strength of the positive association between the Scottish Index of Multiple Deprivation (SIMD) and the rate of hospital admissions due to alcohol misuse after reaching the bottom 10% of SIMD scores. When modelling a categorical variable such as education status we find that accounting for the population distribution can remove significant non-linearity even when analysing individual-level data. This new method improves the accuracy of traditional regression modelling while preserving much of its parsimony and, with the use of standard reporting statistics, its ease of interpretation.
Rob Young has just completed a six-month fellowship at the Scottish Collaboration for Public Health Research and Policy looking at non-linearity in the relationship between SES markers and health status indicators. This fellowship was a break at the end of the 3rd year of his DPhil based in the MRC Functional Genomics Unit, University of Oxford where he worked both computationally and experimentally on noncoding RNAs in the fruit-fly, Drosophila melanogaster.
Talk 2: Frank Popham, School of Geography and Geosciences, University of St Andrews: Comparing health inequalities in Scotland to elsewhere in Europe.
There is growing interest in how the extent of socio-economic inequalities in morbidity and mortality varies across countries. In Europe there have been a number of major comparative studies, the most recent of which covered data from the 1990s. However, Scotland has not been included in this work. So using data from the 1990s and 2000s the aim of the project was to replicate the most recent European work in Scotland. This talk will present the results.
Frank Popham is a research fellow in the School of Geography and Geosciences at the University of St Andrews. He has a social science background and his main research interests are health inequalities and population health.
On Wednesday 29th February 2012 SCPHRP and Health Scotland co-hosted an Adolescent Health and Risk Behaviours Symposium. The Symposium focused on policy, research and practice relating to adolescent health and featured presentations from a variety of speakers, as well as panel discussions and opportunities for Q&A.