Health Inequalities and the Living Wage

Evidence Review 6 - Health inequalities and the living wage Briefing 6 - Health inequalities and the living wage This pair of documents, commissioned by Public Health England, and written by the UCL Institute of Health Equity, address the role of a minimum income in improving health. These papers provide a summary of evidence on the health impacts of living on a low income. They assess the evidence around how the living wage addresses low incomes, health and health inequalities. The living wage is an hourly minimum wage, optional for employers, calculated according to the basic cost of living. Local authorities and other organisations that have implemented the living wage for their staff are presented as case study interventions to show how it is possible, the challenges faced and how they were overcome and any reported income, health and business benefits. The full evidence review and a shorter summary briefing are available to download above. This document is part of a series. An overview document which provides an introduction to this and other documents in the series, and links to the other topic areas, is available on the ‘Local Action on health inequalities’ project page. A video of Michael Marmot introducing the work is also available on our videos page.

Do you look after someone? And are you from a black or minority ethnic background? (English and translations)

This leaflet is for BME (Black and Minority Ethnic) Carers. Carers can be people of all ages including children, young people, parents, older people. There is a cut off slip for BME Carers to fill in with their details. This information can then be sent to the Carer Worker in their local Trust. Details are on the leaflet.

Model-based appraisal of minimum unit pricing for alcohol in Northern Ireland

In 2009, the Sheffield Alcohol Research Group (SARG) at Sheffield University developed the Sheffield Alcohol Policy Model version 2.0 (SAPM) to appraise the potential impact of alcohol policies, including different levels of MUP, for the population of England. In 2013, SARG were commissioned by the DHSSPS and the Department for Social Development to adapt the Sheffield Model to NI in order to appraise the potential impact of a range of alcohol pricing policies. The present report represents the results of this work. Estimates from the Northern Ireland (NI) adaptation of the Sheffield Alcohol Policy Model - version 3 - (SAPM3) suggest: 1. Minimum Unit Pricing (MUP) policies would be effective in reducing alcohol consumption, alcohol related harms (including alcohol-related deaths, hospitalisations, crimes and workplace absences) and the costs associated with those harms. 2. A ban on below-cost selling (implemented as a ban on selling alcohol for below the cost of duty plus the VAT payable on that duty) would have a negligible impact on alcohol consumption or related harms. 3. A ban on price-based promotions in the off-trade, either alone or in tandem with an MUP policy would be effective in reducing alcohol consumption, related harms and associated costs. 4. MUP and promotion ban policies would only have a small impact on moderate drinkers at all levels of income. Somewhat larger impacts would be experienced by increasing risk drinkers, with the most substantial effects being experienced by high risk drinkers. 5. MUP and promotion ban policies would have larger impacts on those in poverty, particularly high risk drinkers, than those not in poverty. However, those in poverty also experience larger relative gains in health and are estimated to marginally reduce their spending due to their reduced drinking under the majority of policies åÊ

The cost of a minimum essential food basket in Northern Ireland : Pilot study for two household types

A good diet and adequate food supply is central to promoting health and wellbeing. A poor quality diet is associated with higher rates of chronic diseases such as type 2 diabetes, obesity, cardiovascular disease and certain cancers. Social and economic conditions impact on diet quality which in turn contributes to health inequalities. This relationship is recognised and addressed at a policy level in NI through the Fitter Future for all framework(1). Access to a healthy diet requires transport, money and skills such as budgeting and food preparation. Food is the most flexible aspect of the household budget due to the fact the consumers can meet hunger and calorie needs on cheaper, nutritionally-poor foods.

The cost of a minimum essential food basket in the Republic of Ireland: Study for six household types.

A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. - See more at: http://www.safefood.eu/Publications/Research-reports/The-cost-of-a-healthy-food-basket.aspx#sthash.RiBpj5no.dpuf A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. - See more at: http://www.safefood.eu/Publications/Research-reports/The-cost-of-a-healthy-food-basket.aspx#sthash.RiBpj5no.dpuf A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. - See more at: http://www.safefood.eu/Publications/Research-reports/The-cost-of-a-healthy-food-basket.aspx#sthash.RiBpj5no.dpuf

IPH response to the DSD consultation on regulations to prohibit or restrict irresponsible promotions of alcohol in Northern Ireland

IPH responded to the Department for Social Development consultation on the banning of certain promotions that may encourage irresponsible and excessive drinking. The consultation relates to regulations Article 57A(2)(d) of the 1996 Licensing Order “involving the supply of unlimited amounts of intoxicating liquor for a fixed charge (including any charge for entry to the premises)” and Article 31A(2)(d) of the Registration of Clubs Order “restricting the price at which the holder of a licence or the licence holder’s servant or agent may sell on licensed premises a package containing two or more intoxicating liquor products”. IPH welcomes this consultation and supports the Department’s proposals to restrict promotions that involve the supply of unlimited amounts of intoxicating liquor for a fixed charge. IPH welcomes this tangible action linked to the renewed commitment to tackling alcohol-related harms on the island of Ireland set out in the Steering Group Report on a National Substance Strategy (Dept of Health, 2012) and in the New Strategic Direction on Alcohol and Drugs (DHSSPS, 2011). IPH considers that irresponsible alcohol promotions can contribute to this burden of physical and mental ill-health, accidental and non-accidental injury and other harms associated with excessive alcohol consumption in Northern Ireland. As previously stated in the IPH submissions on the introduction of powers to prohibit or restrict irresponsible alcohol promotions (Dec, 2010), IPH considers that the issues of promotion and price are inter-related. The effectiveness of the proposed restrictions could be reinforced by the expeditious introduction of minimum unit pricing of alcohol on an all-island basis.

IPH response to the HIQA consultation on the National Demographic Dataset and Guidance for use in health and social care settings in Ireland

The remit of the Institute of Public Health in Ireland (IPH) is to promote cooperation for public health between Northern Ireland and the Republic of Ireland in the areas of research and information, capacity building and policy advice. Our approach is to support Departments of Health and their agencies in both jurisdictions, and maximise the benefits of all-island cooperation to achieve practical benefits for people in Northern Ireland and the Republic of Ireland. IPH have previously responded to consultations to the Department of Health’s Discussion Paper on the Proposed Health Information Bill (June 2008), the Health Information and Quality Authority on their Corporate Plan (Oct 2007), and the Road Safety Authority of Ireland Road Safety Strategy (Jul 2012). IPH supports the development of a national standard demographic dataset for use within the health and social care services. Provided necessary safeguards are put in place (such as ethics and data protection) and the purpose of collecting the information is fully explained to subjects, mandatory provision of a minimum demographic dataset is usually the best way to achieve the necessary coverage and data quality. Demographic information is needed in several forms to support the public health function: Detailed aggregated information for comparison to population counts in order to assess equity of access to healthcare as well as examining population patterns and trends in morbidity and mortality Accurate demographic information for the surveillance of infectious disease outbreaks, monitoring vaccination programmes, setting priorities for public health interventions Linked to other data outside of health and social care such as population data, survey data, and longitudinal studies for research and analysis purposes.   Identify and address public health issues to tackle health inequalities, and to monitor the success of such efforts to tackle them.

The Efficacy of Minimum Unit Pricing, Fiscal and other Pricing Public Policies for Alcohol

This report was commissioned from CJP Consultants Limited by the Department of Health. It sets out the issues relating to hazardous and harmful consumption of alcohol in Ireland. It looks at the international experience and policy response;and makes recommendations about how the problems caused by hazardous alcohol consumption can and should be tackled in Ireland. Click here to download Report on The Efficacy of Minimum Unit Pricing, Fiscal and other Pricing Public Policies for Alcohol PDF 1MB

A guide to working in partnership: employability provision for drug users.

The aim of this guide is to identify the key principles of partnership working and to provide case study examples of how partnership works in practice in employability provision for drug users. Developing and sustaining new and valuable relationships with the world beyond drugs is a key factor in sustainable recovery for drug users. This includes the worlds of employment, training and education. Research suggests that employment can aid the process of recovery. A qualitative study of drug users in Scotland highlighted the importance of employment and other activities to fill the ‘void’ left by drug useThis resource was contributed by The National Documentation Centre on Drug Use.

Interventions to achieve long-term weight loss in obese older people: A systematic review and meta-analysis

Purpose: the prevalence of obesity is rapidly increasing in older adults. Information is required about what interventions are effective in reducing obesity and influencing health outcomes in this age group. Design: systematic review and meta-analysis. Data sources: thirteen databases were searched, earliest date 1966 to December 2008, including Medline, CINAHL, PsycINFO, the Cochrane database and EMBASE. Study selection: we included studies with participants�۪ mean age 60 years and mean body mass index 30 kg/m2, with outcomes at a minimum of 1 year. Data were independently extracted by two reviewers and differences resolved by consensus. Data extraction: nine eligible trials were included. Study interventions targeted diet, physical activity and mixed approaches. Populations included patients with coronary artery disease, diabetes mellitus and osteoarthritis. Results: meta-analysis (seven studies) demonstrated a modest but significant weight loss of 3.0 kg [95% confidence interval (CI) 5.1���0.9] at 1 year. Total cholesterol (four studies) did not show a significant change: ���0.36 mmol/l (95% CI ���0.75 to 0.04). There was no significant change in high-density lipoprotein, low-density lipoprotein or triglycerides. In one study, recurrence of hypertension or cardiovascular events was significantly reduced (hazard ratio 0.65, 95% CI 0.50���0.85). Six-minute walk test did not significantly change in one study. Health-related quality of life significantly improved in one study but did not improve in a second study. Conclusions: although modest weight reductions were observed, there is a lack of high-quality evidence to support the efficacy of weight loss programmes in older people. ��Keywords: obesity, older, weight loss, meta-analysis, elderly, systematic review

Interventions to achieve long-term weight loss in obese older people

Purpose: the prevalence of obesity is rapidly increasing in older adults. Information is required about what interventions are effective in reducing obesity and influencing health outcomes in this age group. Design: systematic review and meta-analysis. Data sources: thirteen databases were searched, earliest date 1966 to December 2008, including Medline, CINAHL, PsycINFO, the Cochrane database and EMBASE. Study selection: we included studies with participants�۪ mean age 60 years and mean body mass index 30 kg/m2, with outcomes at a minimum of 1 year. Data were independently extracted by two reviewers and differences resolved by consensus. Data extraction: nine eligible trials were included. Study interventions targeted diet, physical activity and mixed approaches. Populations included patients with coronary artery disease, diabetes mellitus and osteoarthritis. Results: meta-analysis (seven studies) demonstrated a modest but significant weight loss of 3.0 kg [95% confidence interval (CI) 5.1���0.9] at 1 year. Total cholesterol (four studies) did not show a significant change: ���0.36 mmol/l (95% CI ���0.75 to 0.04). There was no significant change in high-density lipoprotein, low-density lipoprotein or triglycerides. In one study, recurrence of hypertension or cardiovascular events was significantly reduced (hazard ratio 0.65, 95% CI 0.50���0.85). Six-minute walk test did not significantly change in one study. Health-related quality of life significantly improved in one study but did not improve in a second study. Conclusions: although modest weight reductions were observed, there is a lack of high-quality evidence to support the efficacy of weight loss programmes in older people. ��Keywords: obesity, older, weight loss, meta-analysis, elderly, systematic review��