Equity in Action: Advancing LGBTQIA+ Health in Wales

Despite advancements in societal acceptance and legal rights, LGBTQIA+ individuals continue to face significant disparities in mental health, sexual health, and healthcare access. Health inequalities among the LGBTQIA+ communities in Wales present a pressing challenge.

This blog describes the challenges experienced by the LGBTQIA+ communities in Wales regarding health and social care. It features strategic policies that are making difference, ensuring fair health access for all. The blog also highlights transformative efforts that are not only reshaping public health but also setting precedents for inclusivity across the nation.

Authors: Bastien Soto

Assessing public health implications of free trade agreements: The Comprehensive and Progressive Trans-Pacific Partnership Agreement

In 2016, the United Kingdom voted to exit the European Union, which was surrounded by political and social uncertainty. The United Kingdom now negotiates its own trade agreements, and in March 2023, it agreed to join the Comprehensive and Progressive Trans-Pacific Partnership Agreement (CPTPP). A health impact assessment (HIA) was undertaken in 2022–23 to predict the potential impact of the CPTPP on the health and well-being of the Welsh Population. This paper explores the HIA findings and highlights the value of the approach in engaging with stakeholders and informing policymakers. This HIA followed a standard five-step approach which involved a literature review to identify potential health impacts, qualitative interviews with cross-sectoral stakeholders and the development of a community health profile. The HIA identified potential impacts across the wider determinants of health and specific vulnerable population groups. Investor state dispute settlement mechanisms, economic uncertainty and loss of regulatory policy space were identified as key pathways for health impacts. The findings have been beneficial in informing decision-makers to prepare for the CPTPP in Wales using an evidence-informed approach. This work has demonstrated the value of a HIA approach that uses a transparent process to mobilise a wide range of evidence, resulting in transferrable learning.

Authors: Liz Green, Kathryn Ashton+ 6 more
, Leah Silva, Courtney McNamara, Michael Fletcher, Louisa Petchey, Timo Clemens, Margaret Douglas

Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK

Adverse childhood experiences (ACEs) are stressful experiences during childhood such as child maltreatment and exposure to household difficulties including domestic violence, substance abuse, mental illness and family members being in prison. This study analysed data collected from 1,880 adult residents across Wales. It found that those who reported multiple ACEs in their childhood were significantly more likely to perceive they would be unable to cope financially during the cost-of-living crisis, independent of factors including household income level, employment status and residential deprivation.

Authors: Karen Hughes, Mark Bellis+ 4 more
, Katie Cresswell, Rebecca Hill, Kat Ford, Joanne C. Hopkins

Adverse childhood experiences and engagement with healthcare services: Findings from a survey of adults in Wales and England

Adverse childhood experiences (ACEs) are associated with poorer health outcomes yet their association with healthcare engagement remains relatively underexplored, particularly within the UK. This report presents the findings of an online survey with adults resident in Wales and England, developed to explore the association between ACEs and healthcare engagement, including comfort in the use of healthcare services.

Authors: Kat Ford, Karen Hughes+ 3 more
, Katie Cresswell, Rebekah Amos, Mark Bellis

Determining the Public Health Impact of Climate Change: A National Study Using a Health Impact Assessment Approach in Wales

Climate change is recognised as the biggest threat to global health of the 21st century and impacts on health and wellbeing through a range of factors. Due to this, the need to take action in order to protect population health and wellbeing is becoming ever more urgent.

In 2019, Public Health Wales carried out a comprehensive mixed-method Health Impact Assessment (HIA) of climate change. Unlike other risk assessments, it appraised the potential impact of climate change on health and inequalities in Wales through participatory workshops, stakeholder consultations, systematic literature reviews and case studies.

The HIA findings indicate potential impacts across the wider determinants of health and wellbeing. For example, air quality, excess heat/cold, flooding, economic productivity, infrastructure, and community resilience. A range of impacts were identified across population groups, settings, and geographical areas.

These findings can inform decision-makers to prepare for climate change plans and policies using an evidence-informed approach. The work has demonstrated the value of a HIA approach by mobilising a range of evidence through a transparent process, resulting in transferrable learning for others.

Authors: Liz Green, Kathryn Ashton+ 6 more
, Nerys Edmonds, Michael Fletcher, Sumina Azam, Karen Hughes, Phil Wheater, Mark A Bellis

Addressing Single-Use Plastic and Waste in Public Health Wales’ Microbiology Labs

The report highlights the highest carbon emission single-use plastic and waste items used in PHW’s Microbiology Laboratories and identifies recommendations to switch to more sustainable alternatives.

The solutions identified can be replicated across the wider healthcare sector.

Authors: Tracy Evans

Time to Talk Public Health: February 2024 Panel Survey Findings, including a parent boost sample

Time to Talk Public Health is a nationally representative panel of Welsh residents established by Public Health Wales to enable regular public engagement to inform public health policy and practice. Welsh residents were asked their views on a range of public health topics. The survey had a focus on topics relating to children’s health and well-being, including questions of specific relevance to parents. To increase participation of parents in the survey, a parent boost sample was recruited to take part in the survey in addition to the routine general population sample. The February survey focused on the following six topics: parenting information needs, perceptions of breastfeeding, role of education settings in child health, child behaviour strategies, mental well-being, and technology use with family and friends.

Authors: Catherine Sharp, Karen Hughes+ 2 more
, Lewis Brace, Emily Simms

Climate Change and Health in Wales: Views from the public – A demographic breakdown of data

This short report presents a demographic breakdown of data from a national public survey on perceptions of climate change in Wales that was undertaken in 2021/22. The survey explored the population’s views about climate change, its relationship with health, their current climate friendly behaviours, their willingness to engage in action, and views on policy solutions. This report presents data from key survey questions broken down by age group, gender, deprivation quintile, location (rural or urban) and highest qualification. Findings could help tailor awareness campaigns and inform the targeting of key messages and action on climate change in Wales.

Authors: Natasha Judd, Sara Wood+ 1 more
, Karen Hughes

Keeping warm at home during winter in Wales: Differences in heating behaviours, coping strategies, and wellbeing from 2022 to 2023

People’s homes can have a significant impact on their health and well-being. This includes the ability to keep warm at home during winter. This report describes the findings of a national household survey of residents in Wales aged 18 years and over between January to March 2022 (wave one) and repeated between January to March 2023 (wave two). The findings use a sample of 507 participants who completed both survey waves.

Authors: Kat Ford, Nicholas Carella+ 5 more
, Rebecca Hill, Hayley Janssen, Lauren Heywood, Daniella Griffiths, Sumina Azam

Beyond the present: How to apply long-term thinking to reduce health inequalities

This resource aims to inspire all of us to reduce health inequality in Wales and beyond in everything we do, by exploring methods to enable long-term thinking and sharing case studies which show how those approaches have been applied in Wales. It guides users through identifying relevant trends, generating a future vision, and setting a course for a desired future. Methods discussed include horizon scanning, the futures triangle, axes of uncertainty, and scenario planning, among others.

Authors: Petranka Malcheva, Louisa Petchey+ 1 more
, Sara Elias

The Commercial Determinants of Violence: Identifying Opportunities for Violence Prevention through a Public Health-Based Framework Analysis

This paper uses a conceptual framework for the commercial determinants of health to map the potential commercial determinants of violence. It examines commercial practices directly linked with violence (e.g., firearms) and those that indirectly impact violence through the design and promotion of products; employment practices; and impacts on environment, poverty, and local resources. The paper aims to apply the framework to consider its utility for identifying risk and protective factors for violence, existing good practices, challenges, and opportunities for violence prevention.

Authors: Mark Bellis, Sally McManus+ 3 more
, Karen Hughes, Olumide Adisa, Kat Ford

Social and Economic determinants of gender equity: Strategies for a prosperous future for women in Wales

The Welsh Health Equity Status Report initiative (WHESRi) has published a spotlight feature blog to commemorate International Women’s Day. This spotlight feature focuses on gender equity in Wales, emphasizing the social and economic determinants impacting women’s well-being. It highlights persistent gender inequalities across various spheres, including health, employment, and violence, exacerbated by factors like race, disability, and economic status. To address Addressing these challenges requires gender-responsive policies, gender-inclusive budgeting, and an Economy of Well-being framework to promote positive outcomes and empower women towards a healthier and more prosperous future in Wales.

Authors: Zuwaira Hashim, Jo Peden

Identifying and Applying Behaviour Change Techniques

A practical, interactive tool that introduces Behaviour Change Techniques, considered to be the ‘active ingredients’ of behaviour change interventions. The tool walks you through how to identify and deliver Behaviour Change Techniques, drawing on the COM-B model and Behaviour Change Wheel.

Authors: Alice Cline, Nicky Knowles+ 2 more
, Jonathan West, Ashley Gould

Evaluating Behaviour Change Interventions

Written in collaboration with the Central Evaluation Team and Public Health Wales, this is a practical and interactive tool that identifies key points to take into consideration when you’re planning how to test and evaluate your behaviour change intervention.

Authors: Alice Cline, Nicky Knowles+ 5 more
, Jonathan West, Lucia Homolova, Dr Charlotte Grey, Dr Esther Mugweni, Ashley Gould

Self-administered sexual health testing in an open prison setting in Wales: A Health Impact Assessment and Social Return on Investment analysis

This report outlines findings from a study that aims to understand the health impacts and social return on investment of a self-sampling service for Sexually Transmitted Infections (STIs) in an open prison setting in Wales. The study applies an innovative approach by using a Health Impact Assessment (HIA) lens and approach, in combination with the Social Return on Investment (SROI) framework.

Authors: Kathryn Ashton, Aimee Challenger+ 4 more
, Andrew Cotter-Roberts, Christie Craddock, Jordan Williams, Liz Green
International Horizon Scanning and Learning Report: Impact of Poverty on Babies Children and Young People Report 48

International Horizon Scanning and Learning Report: Impact of Poverty on Babies Children and Young People Report 48

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.
In focus: Impact of Poverty on Babies, Children and Young People

Authors: Leah Silva, Lauren Couzens (née Ellis)+ 6 more
, Daniela Stewart, Rachel Bennett, Zuwaira Hashim, Rhiannon Griffiths, Jo Peden, Mariana Dyakova

Time to Talk Public Health: December 2023 Panel Survey Findings

Time to Talk Public Health is a national panel of Welsh residents aged 16+ years established by Public Health Wales enabling regular public engagement to inform public health policy and practice. The panel is designed to be broadly representative of the Welsh population by age, sex, deprivation, ethnicity and health board. This report presents findings from the December 2023 survey covering: Flu and COVID-19 vaccines, Vaccination and pregnancy, NHS 111 Wales Service, and Primary Care Clusters.

Authors: Catherine Sharp, Karen Hughes+ 1 more
, Lewis Brace
Influencing the Health Gap: Multi-Country Perspectives

Influencing the Health Gap: Multi-Country Perspectives

The Welsh Health Equity Status Report initiative (WHESRi) has updated a spotlight feature blog on the innovative decomposition analysis methodology. This now includes the addition on a summary report on a multi-country webinar, with insights from Wales, Italy and Slovenia. The webinar was a solutions-focused session which explored how the application of the decomposition analysis methodology has generated insights into the drivers of health inequalities.

A key finding of the webinar was the need to strengthen the case for investing in well-being and health equity in Wales and beyond through policies and solution-based actions that were identified throughout the webinar.

Authors: Lauren Couzens (née Ellis), Sara Cooklin-Urbano+ 2 more
, Mariana Dyakova, Jo Peden

Affordable homes for health and well-being

People’s homes can have a significant impact on their health and well-being.

This briefing follows our summary briefing ‘Homes for health and well-being’ on what a future of healthy homes in Wales should look like. It focuses on the importance of affordable homes for health and well-being.

We hope that by highlighting the links between housing affordability and health, and by sharing examples of what ‘good’ looks like, this briefing will help stakeholders in the housing system make progress towards a future where affordable homes help to protect and improve the health and well-being of everyone in Wales.

Authors: Manon Roberts, Louisa Petchey

Understanding the burden and costs of unintentional injuries and violence to European health systems

Injuries and violence are a major public health problem in the WHO European Region. Violence is a leading cause of death and with injury, is a major contributor to health care costs. Identifying the burden and costs of injuries and violence to the health care system can be a useful starting point for demonstrating the ‘size of the problem’ to policy makers and in influencing decision-making. This project aimed to estimate the costs of injuries and violence to the health care systems across the WHO European Region. The objectives were to review costing approaches used in the existing literature, identify data to enable robust estimates of the costs of injury and violence and to develop an analytical framework that can be applied uniformly across WHO European Region countries.

Authors: Lisa Jones, Zoe Bell+ 3 more
, Zara Quigg, Karen Hughes, Mark Bellis
The Social Return on Investment of Physical Activity and Nutrition Interventions - a Scoping Review

The Social Return on Investment of Physical Activity and Nutrition Interventions – a Scoping Review

Scarcity of resources for public health and mounting pressures on health systems such as the Covid-19 pandemic, make it vital to evaluate public health interventions and move away from traditional evaluation methods. This is important to understand not just the financial value of public health interventions, but also the wider social, environmental and economic value. This review aims to present the existing evidence base on the Social Return on Investment of physical activity and nutrition interventions, demonstrating the wider social and environmental benefits of these interventions.

Authors: Anna Stielke, Kathryn Ashton+ 2 more
, Andrew Cotter-Roberts, Mariana Dyakova
International Horizon Scanning and Learning Report: Embedding Prevention in Primary and Community Care Report 47

International Horizon Scanning and Learning Report: Embedding Prevention in Primary and Community Care Report 47

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.
In focus: Embedding Prevention in Primary and Community Care

Authors: Leah Silva, Daniela Stewart+ 5 more
, Rachel Bennett, Zuwaira Hashim, Sara Cooklin-Urbano, Lauren Couzens (née Ellis), Mariana Dyakova

The Impact of the COVID-19 Pandemic on Women, Employment and Health Inequalities

The infographic summarises the findings, looking at the Population Groups and Determinants of Health impacted, along with the key statistics, mitigating actions and potential areas of future research. The Explanatory Note goes into further detail on the above, giving a breakdown of the evidence that informed our positive and negative findings on women, employment and health inequalities. It also offers readers the chance to see the HIA methodology that was used by the team.

Authors: Michael Fletcher, Laura Evans+ 3 more
, Lee Parry-Williams, Kathryn Ashton, Liz Green
Journal article first page: Advancing the Social Return on Investment Framework to Capture the Social Value of Public Health Interventions: Semistructured Interviews and a Review of Scoping Reviews

Advancing the Social Return on Investment Framework to Capture the Social Value of Public Health Interventions

Investment in public health has far-reaching impacts, not only on physical health but also on communities, economies, and the environment. There is increasing demand to account for the wider impact of public health and the social value that can be created, which can be captured through the use of the social return on investment (SROI) framework. This study aims to explore the application of SROI and identify areas of advancement for its use in public health.

Authors: Kathryn Ashton, Andrew Cotter-Roberts+ 3 more
, Timo Clemens, Liz Green, Mariana Dyakova

Skills for public health systems leadership: Reflections on practice

The role of public health leaders is ultimately to improve health outcomes, especially for the most vulnerable in our society. Public health leaders have to work across multiple ‘systems’ because the causes of public health issues are often complex and multi-faceted.
This report, via a brief literature review and interviews with public health systems leaders, aims to explore the role of public health leaders in driving change for better health outcomes and the attributes needed to be successful. We hope that the report findings will be useful for future systems leaders to develop their skills in these areas.

Authors: Jo Peden, Dr James Rees+ 2 more
, Sophie Cole, Manon Roberts
Time to Talk Public Health Wales Oct 23 Panel Survey published Dec 23

Time to Talk Public Health: October 2023 Panel Survey Findings

Time to Talk Public Health is a national panel of Welsh residents aged 16+ years established by Public Health Wales enabling regular public engagement to inform public health policy and practice. The panel is designed to be broadly representative of the Welsh population by age, sex, deprivation, ethnicity and health board. This report presents findings from the October 2023 survey covering: 20mph speed limits, vaping, use of antibiotics, HIV, vaccines, addressing inequalities and coronavirus.

Authors: Catherine Sharp, Karen Hughes
Front cover of 'Everybody's Business' - publication by PHW WHO CC

Everybody’s Business: Early Intervention Crime Reduction

This report aims to aid understanding of how multi-agency partners, including police and justice, health and social care, local government, education, and the third sector, can work together to prevent harms that cross the public health and criminal justice landscape, such as violence, substance use and mental health. It provides examples of ways in which multi-agency partners can work to implement whole system approaches to addressing harm and examines areas where early intervention and preventative policing approaches have been or are likely to be successful.

Authors: Zara Quigg, Chloe Smith+ 5 more
, Karen Hughes, Charley Wilson, Nadia Butler, Lisa Jones, Mark Bellis

Research on the impact of the COVID-19 pandemic, and shift to more agile working, on Public Health Wales’ carbon footprint

The report looks at the impact of the COVID-19 pandemic and shift to more agile working on Public Health Wales’ carbon footprint, focusing on both operational and staff homeworking emissions.

The report covers four key areas of emissions, procurement, travel, business/ site and homeworking. The emissions for each area have been calculated for 2019/20 and 2020/21 to compare the difference between the two years, identifying the impact on our carbon footprint for each key area, along with key insights and recommendations.

Authors: Tracy Evans