Post on 21-Jun-2015
Parker Morris standards 1967-80
Dwellings should be fitted with heating
systems that maintain the kitchen and
circulation space at 13oC and the living
and dining spaces at 18oC when the
external temperature is -1oC
Excess winter deathsall cause mortality – East England
Excess winter death by social group of head of household (%)
0
5
10
15
20
25
30
35
Prof Manager Semi-skilled Unskilled
East
Excess winter death by tenure (%)
0
5
10
15
20
25
30
HA LA Owner Privaterented
East
PRIORITISING DISEASES
Disease A Disease B Total
Deaths in all areas 100 100 200
Deaths in deprived areas
20 40 60
Improvement 50% None
Resulting deaths in all areas 50 100 150 (25%)
Resulting deaths in deprived areas 10 40 50 (16.7%)
PRIORITISING DISEASES
Disease A Disease B Total
Deaths in all areas 100 100 200
Deaths in deprived areas
20 40 60
Improvement None 50%
Resulting deaths in all areas 100 50 150
(25%)
Resulting deaths in deprived areas 20 20 40
(33%)
Early successes
• Clean water supply
• Polio immunisation
Flu immunisation
• Over 65s: ¾
• Under 65 at risk: ½
Individual v Herd immunity
• A cluster randomized trial involving 947 Canadian children and adolescents aged 3-15 years who received flu vaccine and 2326 community members who did not receive in 49 Hutterite colonies
• Reduced influenza by 61% in those not vaccinated
Reducing knife injuries
OffendersExcess Mortality Following Release From Prison
0
5
10
15
20
25
30
35
40
45
up to 1 1 up to 2 2 up to 4 4 up to 8 8 up to 13 13 up to 26 26 up to 52 More than52
Total
Weeks since release from Prison
Mo
rtal
ity
Rat
io
Deaths unlreletdto drugs
Drug relateddeaths
Injectable Naltrexone V Placebo
0
20
40
60
80
100
120
Days free
Physiologically notdependent
Licensing
• Taken up by firm in US (Alkermes)
• FDA approved
• Will it ever be licensed in UK?
• Licensed only if commercially attractive
Banning Smoking In Cars With Children
• Ten minute bill by Alex Cunningham
• 84% of public support a ban
• Fine particulate matter in pubs before ban– Average 285 micrograms per square metre
Moving Car With Windows Fully Or Half Open
Moving Car With Windows Closed
The Effect Of Fines
• Smoking associated with deprivation
• Attendance at speed awareness courses
73%
• Seat belt sessions– Offered instead of a fine
Good aspect of Government policy
Health and Social Care Bill
The steps that may be taken … include –
providing financial incentives to encourage individuals to adopt healthier lifestyles
Financial Incentives
“Obese and overweight adults in England could be
paid to lose weight under plans being considered by
the Government. The new strategy to tackle poor
eating habits and sedentary lifestyles includes the
suggestion that people should receive financial
rewards or shopping vouchers for achieving and
maintaining a healthy weight.”
Times Jan 24 2008
NHS Tayside Quit4U
• Smokers in the poorest areas of Dundee offered £150 worth of groceries by the health service if they are able to give up cigarettes
• Participants in 12-week scheme given £12.50 a week by NHS Tayside if a carbon monoxide breath test proves they have not been smoking
• The money will be credited onto an electronic card which cannot be used for cigarettes or alcohol.
Possibilities of working with businesses
To encourage weight loss
– Send two for one vouchers residents of identified
postcodes to buy clothes when there has been
demonstrable reduction in clothes size
To sustain smoking quits
– Savings account (using money saved by quitting) attracting
differential interest if cotinine validated quit at 12 months
Sex workers
Sexually transmitted infections
– Service offered in massage parlours
Exit strategies
– Workers may want to plan their exit